ECIN

SWX-rays of Limbs

C NI - S W

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Describe the injury1. Mechanism2. Neurovascular status3. Open/Closed4. Limb deformity5. Other injuries6. Describe the fracture

Describe the fracture Side (handedness?) Bones involved Any dislocations Transverse, Oblique, Spiral Joint involvement Displacement Angulation ?pathological

Upper Limb Common injuries Classic mechanisms are FOOSH and punches Look for other injuries

Treatment

Analgesia

ReduceImmobilise

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Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut NEW SOUTH WALES

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Lower LimbKnee

Ottawa Rules (knee)Age 55 or over.

Isolated tenderness of the patella (no boney tenderness of the knee other than the patella).

Tenderness at the head of the fibula.

Inability to flex to 90 degrees.

Inability to weight bear both immediately and in the ED (ie, 4 steps – unable to transfer weight twice onto each lower limb regardless of limping).

Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut

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JMO Teaching 2012

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JMO Teaching 2012

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JMO Teaching 2012

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Below the Knee

JMO Teaching 2012

JMO Teaching 2012

“It Really Hurts”

“It ReallyHurts”

“It ReallyHurts”

Ottawa Ankle Rules

Pain in the malleolar zone and any one of the following:

Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus.

Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus.

Inability to bear weight for 4 steps both immediately and in the emergency department.

Emergency Care lnstitut NEW SOUTH WALES

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Salter Harris Classification

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Peroneus terti us tendon

F"eron eus brevis tendon Fl' lan~r fascia

Lateral vi eN

Tuberosity avulsion tfta dure s

IIJ Proximal fltlli metatarsal rtacrures within 1.5 em of the hJ berosj ty

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Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut NEW SOUTH WALES

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Emergency Care lnstitut NEW SOUTH WALES

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Bohler’s Angle:25 - 400

Summary Please view all X-rays and we will discuss in the

workshop Treat the whole patient Analgesia Splint Neurovascular examination, and again Follow up

With thanks: Dr Dane Chalkley EDSS , POW Hospital NSW