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Conference 6/25/2020

As we round out our final virtual conference for the academic year just wanted to give a shoutout to everyone for hanging in there during all the changes. This week we feature lectures from Drs Horton, Wilson, Huggins, Khong and Magee.

We also are celebrating the graduation of our 3rd year class! What a huge milestone. They are absolute rockstars! very proud of all of you. So thankful to have been a part of your growth and education during your residency training and in life in general. I know you will all do great things and cannot wait to see what you will all achieve. Wish you the best of success in the future!

The PGY3 Class!
From left to right – Dr Jain, Dr Cohick, Dr C. Smith, Dr King, Dr T. Smith, Dr Knapp, Dr Carroll – holding up Dr Byrd, Dr MacDonald, Dr Robbins (partially hidden), Dr Wyatt, Dr Kaye.
Image Courtesy of K. Holmes DO.

In other news

We were back in the sim center for some critical procedure review. Everyone rotated through abiding by the limited occupancy guidelines. I think it was much needed.

Onto business

We feature a lecture from Dr Finnie here for your review, recorded prior to the simulation session.

Next up

Check out this review from EMDOCS on wrist and forearm injuries. It is a concise review worth your time.

Have you heard of the Chauffeur fracture? (Also known as Hutchinsons fracture)  It consists of an oblique fracture of the radial styloid process with extension into the radiocarpal joint. Named after Jonathan Hutchinson (1821-1913) known as the “chauffeur fracture” due to it being seen in chauffeurs of this era who had to start cars with hand cranks. The mechanism typically seen in this day and age is FOOSH (fall on outstretched hand) with radial deviation leading to avulsion of the radial styloid secondary to the strength of the radioscapholunate ligament. (6) Management is typically reduction followed by splinting with radial gutter for 6 weeks depending on the degree of displacement, sometimes K wire placement or ORIF if there is displacement or hematoma with inability to reduce, or metaphaseal extension. (8)

Image courtesy of researchgate https://www.researchgate.net/figure/Chauffeur-fracture-backfire-fracture-Hutchinson-fracture-Frontal-radiograph-of-the_fig6_8452212

Next

Lets talk a bit about flexor tenosynovitis. This can occur when the flexor tendon sheath is disrupted and/or infected. It can lead to permanent scarring and possibly even amputation unless it is addressed.

Kanavel’s Signs: Used as diagnostic criteria since published in 1933. (1)

  1. Fusiform digit swelling (most common finding)
  2. Pain with passive extension
  3. Semi-flexed digital posture
  4. Tenderness along flexor tendon sheath (least common finding)
  • Only 50% of patients have all four signs, but most typically have at least 2-3. (2)
  • Tenderness along the flexor tendon sheath can be used to distinguish from other finger infections such as: Herpetic Whitlow, Felon, and Septic Arthritis.
  • Pay attention to penetrating injuries that might have been neglected leading up to the infection.
  • Broad spectrum abx coverage (Van-Zosyn) typically.
  • Immediate surgery consult for open washout


Here is a link to another post regarding subtle and high risk hand injuries that are sometimes overlooked – including compartment syndrome of the forearm and hand, and ulnar collateral ligament injury.

Logo
http://www.emdocs.net/handy-knowledge-subtle-and-high-risk-hand-injuries/

Next

A pediatrics orthopedics case from Northwestern University Ortho cases. (3)

A 15 year old male was running and heard a pop, followed by pain in the right groin and hip. Exam reveals diffuse hip tenderness and pain on passive range of motion. What is the diagnosis and management?

Scroll down for answer:

Answer: avulsion fracture of the anterior superior iliac spine (5)

Management: Conservative – traditionally two to three weeks of limited activities and walking, with partial weight bearing using crutches. (4)


References

  1. Tenosynovitis PF, Pang BH, Teoh L, et al. Factors Affecting the Prognosis of Pyogenic Flexor Tenosynovitis. 2007:1742-1748. doi:10.2106/JBJS.F.01356.
  2. http://www.emdocs.net/handy-knowledge-subtle-and-high-risk-hand-injuries/
  3. https://www.ortho-teaching.feinberg.northwestern.edu/cases/pediatrics/case1/index.html
  4. Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol. 2001;30(3):127–131. doi: 10.1007/s002560000319.
  5. Morelli V, Smith V: Groin Injuries in Athletes. Am Fam Physician 2001; 64:1405-14.
  6. http://www.emdocs.net/wrist-and-distal-forearm-injuries-pearls-pitfalls/
  7. https://www.researchgate.net/figure/Chauffeur-fracture-backfire-fracture-Hutchinson-fracture-Frontal-radiograph-of-the_fig6_8452212
  8. http://www.wheelessonline.com/ortho/chauffeurs_fracture_radial_styloid_fractures


Image credits
K. Holmes DO FACEP
Unsplash @Isaacmsmith @Nicolastissot

Stefan Meyering DO, FAAEM

Dad, Academic EM Attending Physician, Fish Nerd & Backyard Mechanic | APD @ Ft Worth EM | Interests: Graduate Medical Education, Risk Management and Legal Medicine, POCUS, Free Open Access Medical Education (FOAMed), Physician Wellness

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