Emergency Medicine, Orthopedic cases

A couple of days ago I had another shift at the community emergency department in an urban setting and it was a busy day.  I saw 17 patients  in about a 9-hour shift and I saw all kinds of  patients.  The day went by in a whirlwind because I was busy, busy, busy.   I had a couple interesting orthopedic cases.  Oftentimes we see these things in the emergency department and treat them and send them home and they may or may not need any follow up after an accident.  

I had a gentleman who was hit by a car.  This  emergency department, although in a community, is tucked off on a very busy road and oftentimes we get motor vehicle collisions or MVCs or MVAs for motor vehicle accidents and this one was pedestrian versus car or car versus pedestrian, however you would like to say it, and usually it’s not difficult to figure out who’s going to win in that kind of a confrontation.  The car wins every time.  This gentleman was crossing the road and was struck by a car going maybe 20 miles an hour and had his leg run over and was rather fortunate considering the circumstances.  He was brought in by an ambulance and when I went to examine him it became very clear that his main injury complaint was his right foot and ankle, and when I examined him I quickly saw that his right foot was twisted in the wrong direction,  and that’s where most of his pain was coming from.  

I examined him completely from head to toe for other injuries that may not be apparent at first and when I found no other injuries, I returned to examine the right ankle and foot and it was an unstable injury.  So I sent him to X‑ray.  I gave him some pain medication first and then sent him to X‑ray and when he returned it was clear he had fractured his tibia and fibia, and also had another fracture in his ankle and so his foot was completely unstable and could pretty much turn it any direction.  I did not have any doubt there were fractures but we needed the X-ray images to fully diagnose the damage. The fractures needed to be reduced. I sedated him and reduced the fracture and put it in a splint and because of the nature of the injury, and it was unstable, he definitely is going to need surgery to repair the broken bones.  Through the reduction procedure we were able to get it more stable and reduced it back to where it needed to be and into a cast until he can get a surgery.  

The other case I had was a postal service worker who goes and delivers mail door to door by foot, and he came around a corner and three mad lunatic dogs, as he described them, charged him and he sprayed them and they continued to charge him as he ran backwards, and there was an incline in the yard that he didn’t see as he was going backwards and he fell back and landed on an outstretched wrist. He fractured his wrist in two places.  He had a radial and an ulnar fracture and he was in a lot of pain.  This was a stable fracture and we gave him significant amounts of pain medication to ease his pain, and then after we got an X‑ray that showed these fractures it needed to be reduced or set.  We gave him some conscious sedation and waited until he was significant unaware of his surroundings and reduced the wrist to get it back in its place and he will not need an operation, just a cast and he should heal just fine.  

In the emergency department we see orthopedic injuries all the time. These are just a couple from one of my shifts that I treated  in the emergency department.