Fractured Distal Radius (see Arrows)
Complete Posterior Elbow Dislocation
Hello, guest poster ERP here.
If you read my blog, recently I posted about the first “Ice” day of the year. The day that always seems to surprise people, haplessly stepping out onto the stuff in their driveway, front steps, or sidewalk. We always get a big bolus of patients with falls – often with nasty injuries.
Anyway, one of the poor guys I saw that day was the unfortunate owner of the above x-rays (well, ones that were nearly identical to them). He slipped backwards and fell while trying to get into his car. He was in a world of pain (and yes, before everyone goes crayzee, he got PLENTY of IV narcotics!). Realising that I had to reduce that dislocated elbow, and since he had not eaten or drunk anything since the night before, he was a perfect candidate for Dr Conrad Murray’s favourite drug, Propofol (administered by an anaesthesiologist since myself and my PA were doing the reduction – it can be hard to monitor the airway and do a procedure at the same time). Since I had to reduce the elbow (you really should not wait very long to do this), I figured why not try to reduce the distal radius fracture as well? (Not being an orthopaedist, I have only reduced a few of them, usually with the assistance of one). I figured that worse case scenario, he would need another reduction when he followed up with ortho in a few days.
We put the guy out and the elbow reduced easily – return to full range of motion was achieved in short order. Then I bent and yanked on that smashed wrist. The crunching sounds always sort of make me queasy but that is the way it is. I splinted the whole arm from shoulder down to the fingers and ordered the post-reduction X-rays. I thought they looked OK but what do I know? I could tell the elbow was in but I don’t know all those myriad of angles that orthopaedists have to memorise. (for most fractures, there is an angle between the fracture segment and the rest of the bone that you shoot for – and that is what determines if the reduction is successful and not requiring another attempt). About an hour later, the orthopod came in – he had a slew of patients as you can imagine that day – and looked at my handiwork. He deemed the reduction “acceptable” and appeared to be thankful that I had made his day a little easier. I felt like a med student who did his or her first suturing job that did not have to be redone by the attending who came to supervise! Now, I hope he will come in a little faster when I REALLY need him for that drunk guy with an open tib-fib fracture who will inevitably come in at 3am on a Friday night!