1. More random orthopaedic injuries in ED
Dr Donna Mills
FACEM
Caloundra

3. Galeazzi # radius – often distal/medial third junctions
Dislocation DRUJ
FOOSH
Up to 7% forearm fractures
Adults – ORIF; paeds – closed reduction
Cx – AIN or radial nerve palsy

5. Monteggia # proximal third of ulna with dislocation of radial head
Hyperpronation FOOSH
ORIF

7. Smith’s fracture reverse colle’s fracture
distal fracture fragment is displaced volarly (ventrally)
Fall onto flexed wrist

9. Barton’s
intra-articular # of DR with dislocation of the radiocarpal joint
Can be volar (most common) or dorsal
FOOSH with wrist in volar flexion or dorsiflexion

10. Volar Barton’s

11. Dorsal Barton’s

12. Barton’s many fail nonoperative treatment
Refer for early ortho input
manipulative reduction is same as for colle’s/smith’s #

15. Anterior shoulder dislocation
Most common
Bimodal age distribution

16. Anterior shoulder dislocation
Anterior dislocations can be further divided according to where the humeral head comes to lie:
subcoracoid: most common
subglenoid
subclavicular
intrathoracic: very rare

17. Anterior shoulder dislocation
Surgical repair is not required for dislocation per se, but rather to treat complications and associated injuries which include: 
Shoulder instability
Hills-Sach’s lesion
Bankart lesion
damage to the axillary artery or brachial plexus
intraarticular loose body

18. Hills-Sach’s lesion

19. Hills-Sach’s lesion
cortical depression in the posterolateral head of the humerus
results from forceful impaction of the humeral head against the anteroinferior glenoid rim when shoulder dislocated anteriorly

20. Bankart lesion
detachment of the anterior inferior labrum from the underlying glenoid
 labral only ("soft Bankart"), or involve the bony margin ("bony Bankart“)

24. Posterior shoulder dislocation
2-4% of presentations
~50% posterior shoulder dislocations go undiagnosed on initial presentation
FOOSH onto internally rotated arm

26. Inferior shoulder dislocation
Luxatio erecta
hyper-abduction of the arm that forces the humeral head against the acromion
high complication rate  

29. Knee dislocation Urgent reduction under PS NV Ax pre and post
If compromised – urgent vascular
If not – imaging (eg CTA)
Admission for vascular/perfusion obs

31. Native Hip Dislocation
Posterior (80-90%), anterior and central dislocations
marker for a high force mechanism
Assoc injuries
Sciatic nerve (20%)
AVN
Vascular injury less common
Urgent reduction improves outcomes

33. Prosthetic hip dislocation
occurs in 1-4% of primary THR and up to 16% in revision cases
Contributing factors:
looseness of hip (improper neck length)
component malposition
Alcoholism

34. Reduction method assistant provides downward traction on the pelvis
proceduralist should step up onto the bed, standing over the patient
grasp the patient's leg between arm and armpit, leaving both hands free to grasps the knee
use legs to effect an appropriate amount of traction
use hands to internally and externally rotate hip in order to guide the hip into a reduced position 

36. Segond fracture Avulsion # lateral aspect of the tibial plateau
~75% of cases associated with ACL disruption
result of internal rotation and varus stress
Assoc extensive ligamentous injury requires surgical intervention

38. Tillaux fracture
Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis
occurs in older children when the medial aspect of the distal tibial growth plate has started to fuse 

39. Tillaux fracture
Operative reduction and fixation is required when displacement is marked or unable to be eliminated with closed reduction

41. Pilon fracture
axial loading injury which drives the talus into the tibial plafond
Pilon is the French word for pestle
large number of patients will have pain even after 2 years post injury

43. Maisonneuve fracture unstable fracture
# medial tibial malleolus and/or disruption of the distal tibiofibular syndesmosis
# proximal fibula shaft
deltoid ligament can be frequently disrupted

45. Lis Franc fracture/dislocation
Lis franc joint is the articulation of the 1st 3 MTs with the cuneiforms
Lis franc ligament attaches the medial cuneiform to the 2nd metatarsal base on the plantar aspect of the foot. Its integrity is crucial to the stability of the Lisfranc joint.

46. Lis Franc fracture/dislocation
Homolateral
lateral displacement of the 1st to 5th metatarsals, or of 2nd to 5th metatarsals where the 1st MTP joint remains congruent
Divergent 
lateral dislocation of the 2nd to 5th metatarsals with medial dislocation of the 1st metatarsal  

47. Lis franc fracture/dislocation
Some studies advocate ORIF if >2mm diastasis
Others report no correlation between the degree of diastasis and the eventual functional outcome
All studies indicate that timely diagnosis facilitates treatment and decreases long-term disability