Additional Information
Book Details
Abstract
Fracture Management for Primary Care provides the guidance you need to evaluate and treat common fractures, as well as identify uncommon fractures that should be referred to a specialist. Drs. M. Patrice Eiff and Robert Hatch emphasize the current best guidelines for imaging and treating fractures so that you can make accurate identifications and select appropriate treatment. Detailed descriptions and illustrations combined with evidence-based coverage give you the confidence you need to make the right decisions. Online access to procedural videos and patient handouts at expertconsult.com make this quick, practical resource even more convenient for primary care clinicians who manage fractures.
- Access the information you need, the way you need it with a template format for presenting each type of fracture.
- Diagnose fractures accurately with the many high-quality images.
- Clearly see the anatomic relationships of bones and joints through schematic illustrations.
- Reference key information quickly and easily thanks to one-page management tables that summarize pertinent aspects of diagnosis and treatment.
- Treat displaced fractures using detailed, step-by-step descriptions of the most common reduction techniques.
- Access the fully searchable text online at expertconsult.com, along with video clips of reduction maneuvers and downloadable patient education and rehabilitation instruction handouts.
- Accurately identify fractures using optimal imaging guidelines.
- Apply splints and casts with confidence thanks to detailed descriptions and illustrations of technique.
- Tap into the latest best practices through more evidence-based coverage and updated references.
- Effectively manage emergency situations using guidelines for emergent referral, greater detail regarding methods for closed reductions for fractures and dislocations, and more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Fracture Management for Primary Care, 3/e | i | ||
| Copyright Page | iv | ||
| contributors | v | ||
| preface | vii | ||
| introduction | ix | ||
| Fracture Management: A Personal View | ix | ||
| Table Of Contents | xi | ||
| Video contents | xiii | ||
| 1 Fracture Management by Primary Care Providers | 1 | ||
| Primary Care Physicians | 1 | ||
| Nurse Practitioners and Physician Assistants | 2 | ||
| References | 3 | ||
| 2 General Principles of Fracture Care | 5 | ||
| Bone Composition | 5 | ||
| Fracture Healing | 5 | ||
| Inflammation | 5 | ||
| Repair | 5 | ||
| Remodeling | 6 | ||
| Factors That Influence Fracture Healing | 6 | ||
| Potential Fracture Sites | 6 | ||
| Fracture Description | 7 | ||
| Fracture Type | 7 | ||
| Fracture Displacement | 8 | ||
| Radiographic Interpretation | 9 | ||
| Fracture Selection | 10 | ||
| Referral Decisions | 10 | ||
| Complicated Fractures Requiring Urgent Action or Consultation | 10 | ||
| Life-Threatening Conditions | 13 | ||
| Arterial Injury | 14 | ||
| Nerve Injury | 15 | ||
| Compartment Syndrome | 15 | ||
| Open Fractures | 15 | ||
| Tenting of the Skin | 16 | ||
| Significant Soft Tissue Damage | 16 | ||
| Complicated Fractures That Often Require Referral | 16 | ||
| Overview of Acute Management | 17 | ||
| Initial Assessment | 17 | ||
| Radiographic Studies | 17 | ||
| Immobilization | 17 | ||
| Other Acute Measures | 18 | ||
| Timing of the Initial Follow-up Visit | 19 | ||
| Overview of Definitive Care | 19 | ||
| Casting | 19 | ||
| Cast Materials | 19 | ||
| Type of Cast | 19 | ||
| Positioning of the Extremity | 19 | ||
| Confirming Fracture Position After Casting | 19 | ||
| Follow-up Visits | 19 | ||
| Stable Fractures | 19 | ||
| Cast checks | 19 | ||
| Replacing casts | 20 | ||
| Assessment of healing | 20 | ||
| Assessment of function after the cast is removed | 20 | ||
| Unstable Fractures | 20 | ||
| Monitoring fracture position before healing occurs | 20 | ||
| Assessment of healing | 21 | ||
| Stress Fractures | 21 | ||
| Clinical Presentation | 21 | ||
| Imaging | 22 | ||
| Indications for Orthopedic Referral | 22 | ||
| Treatment | 23 | ||
| Return to Work or Sports | 23 | ||
| Late Fracture Complications | 23 | ||
| Complex Regional Pain Syndrome | 23 | ||
| Clinical Features | 23 | ||
| Diagnosis | 23 | ||
| 3 Finger Fractures | 36 | ||
| Distal Phalanx Fractures | 36 | ||
| Anatomic Considerations | 36 | ||
| Mechanism of Injury | 36 | ||
| Clinical Presentation | 36 | ||
| Imaging | 36 | ||
| Indications for Orthopedic Referral | 37 | ||
| Emergent Referral | 37 | ||
| Routine Referral | 37 | ||
| Initial Treatment | 37 | ||
| Nail Bed Injury | 38 | ||
| Follow-up Care | 38 | ||
| Return to Work or Sports | 38 | ||
| Complications | 38 | ||
| Pediatric Considerations | 38 | ||
| Mallet Finger | 39 | ||
| Mechanism of Injury | 39 | ||
| Clinical Presentation | 39 | ||
| Imaging | 39 | ||
| Indications for Orthopedic Referral | 39 | ||
| Initial Treatment | 40 | ||
| Follow-up Care | 40 | ||
| Return to Work or Sports | 41 | ||
| Complications | 41 | ||
| Extensor Lag | 41 | ||
| Late Mallet Finger | 41 | ||
| Pediatric Considerations | 42 | ||
| Flexor Digitorum Profundus Avulsion (Jersey Finger) | 42 | ||
| Anatomic Considerations | 42 | ||
| Type I | 43 | ||
| Type II | 43 | ||
| Type III | 43 | ||
| Mechanism of Injury | 44 | ||
| Clinical Presentation | 44 | ||
| Imaging | 44 | ||
| Treatment | 44 | ||
| Return to Work or Sports | 44 | ||
| Complications | 44 | ||
| Pediatric Considerations | 44 | ||
| Distal Interphalangeal Joint Dislocation | 44 | ||
| Middle Phalanx Shaft Fractures (Adult) | 45 | ||
| Anatomic Considerations | 45 | ||
| Mechanism of Injury | 45 | ||
| Clinical Presentation | 45 | ||
| Imaging | 45 | ||
| Indications for Orthopedic Referral | 46 | ||
| Initial Treatment | 46 | ||
| Nondisplaced Fractures | 46 | ||
| Displaced or Angulated Fractures | 46 | ||
| Follow-up Care | 47 | ||
| Nondisplaced Fractures | 47 | ||
| Stable Fractures after Closed Reduction | 47 | ||
| Return to Work or Sports | 47 | ||
| Complications | 47 | ||
| Middle Phalanx Fractures (Pediatric) | 47 | ||
| Extraphyseal Fractures | 47 | ||
| Physeal Fractures | 47 | ||
| Anatomic Considerations | 47 | ||
| Mechanism of Injury | 47 | ||
| Clinical Presentation | 47 | ||
| Imaging | 48 | ||
| Indications for Orthopedic Referral | 48 | ||
| Initial Treatment | 48 | ||
| Follow-up Care | 48 | ||
| Avulsion Fracture of the Central Slip of the Extensor Tendon | 48 | ||
| Lateral Avulsion Fractures | 48 | ||
| Proximal Interphalangeal Joint Injuries | 48 | ||
| Anatomic Considerations | 48 | ||
| Volar Plate Injuries | 49 | ||
| Mechanism of Injury | 49 | ||
| Clinical Presentation | 49 | ||
| Imaging | 49 | ||
| Indications for Orthopedic Referral | 50 | ||
| Initial Treatment | 50 | ||
| 4 Metacarpal Fractures | 63 | ||
| Metacarpal Head | 63 | ||
| Anatomic Considerations | 63 | ||
| Mechanism of Injury | 63 | ||
| Clinical Presentation | 63 | ||
| Imaging | 63 | ||
| Indications for Orthopedic Referral | 63 | ||
| Initial Treatment | 63 | ||
| Follow-up Care | 64 | ||
| Complications | 65 | ||
| Return to Work or Sports | 65 | ||
| Pediatric Considerations | 65 | ||
| Metacarpal Neck | 65 | ||
| Anatomic Considerations | 65 | ||
| Mechanism of Injury | 66 | ||
| Clinical Presentation | 66 | ||
| Imaging | 66 | ||
| Indications for Orthopedic Referral | 66 | ||
| Initial Treatment | 66 | ||
| Nondisplaced Fractures (Second or Third Metacarpal) and Fractures with Mild Angulation (Fourth or Fifth Metacarpal) | 66 | ||
| Fractures with Significant Angulation or Pseudoclawing (Fourth or Fifth Metacarpal) | 67 | ||
| Method of Reduction | 68 | ||
| Follow-up Care | 68 | ||
| Complications | 69 | ||
| Return to Work or Sports | 69 | ||
| Pediatric Considerations | 70 | ||
| Metacarpal Shaft | 70 | ||
| Anatomic Considerations | 70 | ||
| Mechanism of Injury | 70 | ||
| Clinical Presentation | 71 | ||
| Imaging | 71 | ||
| Indications for Orthopedic Referral | 71 | ||
| Initial Treatment | 71 | ||
| Nondisplaced Fractures | 71 | ||
| Angulated Fractures | 71 | ||
| Method of Reduction | 72 | ||
| Follow-up Care | 73 | ||
| Complications | 73 | ||
| Return to Work or Sports | 73 | ||
| Pediatric Considerations | 73 | ||
| Metacarpal Base | 74 | ||
| Anatomic Considerations | 74 | ||
| Mechanism of Injury | 74 | ||
| Clinical Presentation | 74 | ||
| Imaging | 75 | ||
| Indications for Orthopedic Referral | 75 | ||
| Initial Treatment | 75 | ||
| Nondisplaced Fractures (Second, Third, and Fourth Metacarpals) | 75 | ||
| Displaced Fractures (Second, Third, and Fourth Metacarpals) | 75 | ||
| Follow-up Care | 76 | ||
| Complications | 76 | ||
| Return to Work or Sports | 76 | ||
| Pediatric Considerations | 76 | ||
| Dislocations of the Carpometacarpal Joint | 77 | ||
| Anatomic Considerations | 77 | ||
| Mechanism of Injury | 77 | ||
| Clinical Presentation | 77 | ||
| Imaging | 77 | ||
| Indications for Referral | 78 | ||
| Initial Treatment | 78 | ||
| Follow-up Care | 78 | ||
| Complications | 78 | ||
| Return to Sports or Work | 78 | ||
| First Metacarpal Fractures (Adult) | 78 | ||
| Anatomic Considerations | 78 | ||
| Mechanism of Injury | 79 | ||
| Clinical Presentation | 79 | ||
| Imaging | 79 | ||
| Indications for Orthopedic Referral | 79 | ||
| Initial Treatment | 80 | ||
| Nonangulated Fractures | 80 | ||
| Angulated Fractures | 80 | ||
| Follow-up Care | 80 | ||
| Complications | 80 | ||
| Return to Work or Sports | 81 | ||
| First Metacarpal Fractures (Pediatric) | 81 | ||
| Clinical Presentation | 81 | ||
| Imaging | 81 | ||
| Indications for Orthopedic Referral | 81 | ||
| Initial Treatment | 82 | ||
| Follow-up Care | 82 | ||
| Return to Sports | 82 | ||
| Complications | 82 | ||
| References | 83 | ||
| 5 Carpal Fractures | 84 | ||
| Scaphoid Fractures (Adult) | 84 | ||
| Anatomic Considerations | 84 | ||
| Mechanism of Injury | 84 | ||
| Clinical Presentation | 84 | ||
| Imaging | 85 | ||
| Indications for Orthopedic Referral | 86 | ||
| Initial Treatment | 87 | ||
| Suspected Fracture with Radiographs That Show No Abnormalities | 87 | ||
| Nondisplaced Fracture | 88 | ||
| Displaced Fracture | 89 | ||
| Follow-up Care | 89 | ||
| Nondisplaced Fracture | 90 | ||
| Return to Work or Sports | 90 | ||
| Complications | 90 | ||
| Pediatric Scaphoid Fractures | 90 | ||
| Anatomic Considerations | 90 | ||
| Mechanism of Injury | 90 | ||
| Clinical Presentation | 91 | ||
| Imaging | 91 | ||
| Pseudo-Terry Thomas Sign | 91 | ||
| Further Imaging | 91 | ||
| Indications for Orthopedic Referral | 91 | ||
| Initial Treatment | 91 | ||
| Follow-up Care | 91 | ||
| Return to Sports | 91 | ||
| Complications | 91 | ||
| Triquetrum Fractures | 92 | ||
| Anatomic Considerations | 92 | ||
| Mechanism of Injury | 92 | ||
| Clinical Presentation | 92 | ||
| Imaging | 92 | ||
| Indications for Orthopedic Referral | 93 | ||
| Treatment | 93 | ||
| Return to Work or Sports | 93 | ||
| Complications | 93 | ||
| Pediatric Considerations | 93 | ||
| Lunate Fractures | 93 | ||
| Anatomic Considerations | 93 | ||
| Mechanism of Injury | 94 | ||
| Clinical Presentation | 94 | ||
| Imaging | 95 | ||
| Indications for Orthopedic Referral | 95 | ||
| Treatment | 95 | ||
| Return to Work or Sports | 95 | ||
| Pediatric Considerations | 95 | ||
| Hamate Fractures | 96 | ||
| Hook of the Hamate | 96 | ||
| Anatomic Considerations | 96 | ||
| Mechanism of Injury | 96 | ||
| Clinical Presentation | 96 | ||
| Imaging | 96 | ||
| Indications for Orthopedic Referral | 97 | ||
| Treatment | 97 | ||
| Return to Work or Sports | 97 | ||
| Body of the Hamate | 97 | ||
| Capitate Fractures | 97 | ||
| Scaphocapitate Syndrome | 98 | ||
| Pediatric Considerations | 98 | ||
| Pisiform Fractures | 98 | ||
| Trapezium Fractures | 98 | ||
| Trapezoid Fractures | 98 | ||
| Carpal Dislocations | 99 | ||
| Mechanism of Injury | 99 | ||
| Clinical Presentation | 99 | ||
| Scapholunate Dissociations | 99 | ||
| Perilunate Dislocation | 99 | ||
| Imaging | 100 | ||
| Treatment and Referral | 100 | ||
| Complications | 101 | ||
| References | 101 | ||
| 6 Radius and Ulna Fractures | 102 | ||
| Distal Radius Fractures (Adult) | 102 | ||
| Anatomic Considerations | 102 | ||
| Classification | 102 | ||
| Mechanism of Injury | 103 | ||
| Clinical Presentation | 103 | ||
| Imaging | 104 | ||
| Indications for Orthopedic Referral | 104 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 104 | ||
| Nonemergent Referral (Within 24 to 48 Hours) | 105 | ||
| Initial Treatment | 105 | ||
| Nondisplaced Extraarticular Fractures (Frykman Type I or II) | 106 | ||
| Displaced Extraarticular Fractures (Frykman Type I or II) | 106 | ||
| Reduction Method with Finger Traps | 106 | ||
| Reduction Method without Finger Traps | 107 | ||
| Intraarticular Fractures (Frykman Types III to VIII) | 108 | ||
| Follow-up Care | 108 | ||
| Nondisplaced Extraarticular Fractures | 108 | ||
| Extraarticular Fractures After Closed Reduction | 108 | ||
| Return to Work or Sports | 108 | ||
| Complications | 109 | ||
| Smith’s Fracture | 109 | ||
| Barton’s Fracture | 110 | ||
| Hutchinson’s Fracture | 110 | ||
| Distal Radius Fractures (Pediatric) | 110 | ||
| Metaphyseal Fractures | 110 | ||
| Mechanism of Injury | 111 | ||
| Clinical Presentation | 111 | ||
| Imaging | 111 | ||
| Indications for Orthopedic Referral | 112 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 112 | ||
| Nonemergent Referral (24 to 48 Hours) | 112 | ||
| Treatment | 112 | ||
| Torus Fractures | 112 | ||
| Greenstick Fractures | 112 | ||
| Complete Fractures | 114 | ||
| Complications | 114 | ||
| Physeal Fractures | 114 | ||
| Anatomic Considerations | 114 | ||
| Mechanism of Injury | 114 | ||
| Clinical Presentation | 114 | ||
| Imaging | 114 | ||
| Indications for Orthopedic Referral | 115 | ||
| Initial Treatment | 115 | ||
| Nondisplaced or Suspected Fractures | 115 | ||
| Displaced Fractures | 116 | ||
| Follow-up Care | 116 | ||
| Complications | 117 | ||
| Fractures of the Shaft of the Radius (Adult): Galeazzi’s Fracture | 117 | ||
| Anatomic Considerations | 117 | ||
| Mechanism of Injury | 117 | ||
| Clinical Presentation | 117 | ||
| Imaging | 117 | ||
| Treatment | 118 | ||
| Return to Work or Sports | 118 | ||
| Complications | 118 | ||
| Pediatric Considerations | 118 | ||
| Fractures of the Shaft of the Radius (Pediatric) | 119 | ||
| Mechanism of Injury | 119 | ||
| Clinical Presentation | 119 | ||
| Imaging | 119 | ||
| Indications for Orthopedic Referral | 120 | ||
| Initial Treatment | 120 | ||
| Nondisplaced Fractures | 120 | ||
| Displaced Fractures | 120 | ||
| Follow-up Care | 121 | ||
| Return to Sports | 121 | ||
| Complications | 121 | ||
| Both-Bone Forearm Fractures (Adult) | 121 | ||
| Anatomic Considerations | 121 | ||
| Mechanism of Injury | 121 | ||
| Clinical Presentation | 121 | ||
| Imaging | 122 | ||
| Indications for Orthopedic Referral | 122 | ||
| Initial Treatment | 122 | ||
| Nondisplaced Fractures | 122 | ||
| Displaced Fractures | 123 | ||
| Follow-up Care | 123 | ||
| Nondisplaced Fractures | 123 | ||
| Displaced Fractures | 124 | ||
| Return to Work or Sports | 124 | ||
| Complications | 124 | ||
| Both-Bone Forearm Fractures (Pediatric) | 124 | ||
| Mechanism of Injury | 124 | ||
| Clinical Presentation | 124 | ||
| Imaging | 124 | ||
| Treatment | 125 | ||
| Fractures of the Ulnar Shaft | 125 | ||
| “Nightstick” Fractures | 125 | ||
| Monteggia’s Fractures (Adult) | 126 | ||
| Mechanism of Injury | 126 | ||
| Clinical Presentation | 126 | ||
| Imaging | 127 | ||
| Treatment | 127 | ||
| Complications | 127 | ||
| Monteggia’s Fractures (Pediatric) | 127 | ||
| Classification | 127 | ||
| Clinical Presentation | 127 | ||
| Imaging | 128 | ||
| Indications for Orthopedic Referral | 128 | ||
| Treatment | 128 | ||
| Return to Sports | 128 | ||
| Complications | 128 | ||
| Wrist Dislocations (Radiocarpal Joint) | 128 | ||
| References | 129 | ||
| 7 Elbow Fractures | 130 | ||
| Radial Head and Neck | 130 | ||
| Anatomic Considerations | 130 | ||
| Mechanism of Injury | 130 | ||
| Clinical Presentation | 130 | ||
| Imaging | 131 | ||
| Indications for Orthopedic Referral | 132 | ||
| Emergent Referral | 132 | ||
| Nonemergent Referral | 132 | ||
| Initial Treatment | 133 | ||
| Follow-up Care | 135 | ||
| Rehabilitation | 135 | ||
| Return to Work or Sports | 135 | ||
| Complications | 135 | ||
| Pediatric Considerations | 135 | ||
| Radial Head and Neck Fractures | 135 | ||
| Radial Head Subluxation (Nursemaid’s Elbow) | 135 | ||
| Olecranon | 138 | ||
| Anatomic Considerations | 138 | ||
| Mechanism of Injury | 138 | ||
| Clinical Presentation | 138 | ||
| Imaging | 138 | ||
| Indications for Orthopedic Referral | 138 | ||
| Initial Treatment | 139 | ||
| Follow-up Care | 139 | ||
| Return to Work or Sports | 139 | ||
| Complications | 139 | ||
| Pediatric Considerations | 140 | ||
| Coronoid Process | 140 | ||
| Distal Humerus (Adult) | 141 | ||
| Anatomic Considerations | 141 | ||
| Supracondylar and Transcondylar Fractures | 141 | ||
| Mechanism of Injury | 141 | ||
| Clinical Presentation | 141 | ||
| Imaging | 142 | ||
| Indications for Orthopedic Referral | 142 | ||
| Emergent Referral | 142 | ||
| Nonemergent Referral | 142 | ||
| Initial Treatment | 143 | ||
| Follow-up Care | 143 | ||
| Return to Work or Sports | 143 | ||
| Complications | 143 | ||
| Intercondylar Fractures | 144 | ||
| 8 Humerus Fractures | 154 | ||
| Anatomic Considerations | 154 | ||
| Proximal Humerus Fractures (Adult) | 154 | ||
| Mechanism of Injury | 154 | ||
| Clinical Presentation | 154 | ||
| Differential Diagnosis | 155 | ||
| Imaging | 155 | ||
| Shoulder Radiography | 155 | ||
| Fracture Patterns | 157 | ||
| Indications for Orthopedic Referral | 158 | ||
| Initial Treatment | 158 | ||
| Follow-up Care | 159 | ||
| Complications | 161 | ||
| Return to Work or Sports | 161 | ||
| Proximal Humerus Fractures (Pediatric) | 161 | ||
| Mechanism of Injury | 162 | ||
| Clinical Presentation | 162 | ||
| Imaging | 162 | ||
| Indications for Orthopedic Referral | 162 | ||
| Treatment | 163 | ||
| Complications | 163 | ||
| Midshaft Fractures of the Humerus | 163 | ||
| Mechanism of Injury | 163 | ||
| Clinical Presentation | 163 | ||
| Imaging | 163 | ||
| Indications for Orthopedic Referral | 163 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 163 | ||
| Nonemergent Referral (Within a Few Days) | 163 | ||
| Initial Treatment | 164 | ||
| Follow-up Care | 165 | ||
| Functional Bracing | 165 | ||
| Hanging Arm Cast | 165 | ||
| Rehabilitation | 167 | ||
| Complications | 167 | ||
| Return to Work or Sports | 168 | ||
| Pediatric Considerations | 168 | ||
| Shoulder (Glenohumeral) Dislocations | 169 | ||
| Anterior Dislocations | 169 | ||
| Mechanism of Injury | 169 | ||
| Clinical Presentation | 169 | ||
| Imaging | 170 | ||
| Indications for Orthopedic Referral | 170 | ||
| Initial Treatment | 171 | ||
| Reduction Technique | 171 | ||
| Scapular Manipulation. | 171 | ||
| Stimson’s Technique. | 171 | ||
| Traction Countertraction. | 171 | ||
| Follow-up Care | 172 | ||
| Recurrent Dislocations | 172 | ||
| Posterior Dislocations | 172 | ||
| Inferior Dislocations (Luxatio Erecta) | 173 | ||
| References | 173 | ||
| 9 Clavicle and Scapula Fractures | 175 | ||
| Clavicle Fractures | 175 | ||
| Anatomic Considerations | 175 | ||
| Mechanism of Injury | 175 | ||
| Fractures of the Middle Third of the Clavicle | 175 | ||
| Clinical Presentation | 175 | ||
| Imaging | 176 | ||
| Indications for Orthopedic Referral | 176 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 176 | ||
| Nonemergent Referral (Within A Few Days of Injury) | 176 | ||
| Initial Treatment | 177 | ||
| Follow-up Care | 178 | ||
| Return to Work or Sports | 178 | ||
| Complications | 178 | ||
| Pediatric Considerations | 178 | ||
| Birth Injuries | 178 | ||
| Fractures of the Distal Third of the Clavicle | 179 | ||
| Clinical Presentation | 179 | ||
| Imaging | 179 | ||
| Indications for Orthopedic Referral. | 179 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 179 | ||
| Nonemergent Referral (Within A Few Days of Injury) | 180 | ||
| Initial Treatment | 180 | ||
| Follow-Up Care | 180 | ||
| Return to Work or Sports | 180 | ||
| Complications | 180 | ||
| Pediatric Considerations | 180 | ||
| Fractures of the Proximal Third of the Clavicle | 181 | ||
| Clinical Presentation | 181 | ||
| Imaging | 181 | ||
| Indications for Orthopedic Referral | 181 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 181 | ||
| Nonemergent Referral (Within A Few Days from Injury) | 181 | ||
| Initial Treatment | 182 | ||
| Follow-up Care | 182 | ||
| Pediatric Considerations | 182 | ||
| Scapula Fractures | 183 | ||
| Anatomic Considerations | 183 | ||
| Mechanism of Injury | 183 | ||
| Clinical Presentation | 184 | ||
| Imaging | 184 | ||
| Indications for Orthopedic Referral | 184 | ||
| Initial Treatment | 184 | ||
| Follow-up Care | 184 | ||
| General Considerations | 184 | ||
| Specific Considerations | 185 | ||
| Body and Spine | 185 | ||
| Glenoid Neck | 185 | ||
| Glenoid | 185 | ||
| Acromion | 185 | ||
| Coracoid | 185 | ||
| Return to Work or Sports | 185 | ||
| References | 186 | ||
| 10 Spine Fractures | 187 | ||
| Cervical Spine Fractures (Adult) | 187 | ||
| Anatomic Considerations | 187 | ||
| Mechanism of Injury | 187 | ||
| Clinical Presentation | 187 | ||
| Imaging | 188 | ||
| Imaging Decision Rules | 189 | ||
| Plain Radiographs | 189 | ||
| All vertebrae on the Lateral View | 190 | ||
| Presence of Lordosis | 190 | ||
| Vertebral Alignment | 190 | ||
| Spinolaminal Line | 190 | ||
| Spinous Processes | 191 | ||
| Odontoid View | 191 | ||
| Soft Tissue Examination | 191 | ||
| Flexion-Extension Radiographs | 191 | ||
| Computed Tomography | 191 | ||
| Magnetic Resonance Imaging | 192 | ||
| Fracture Patterns | 192 | ||
| C1 Fractures | 192 | ||
| C2 fractures | 192 | ||
| Facet Dislocations | 192 | ||
| Wedge Fractures | 193 | ||
| Flexion Teardrop Fractures | 195 | ||
| Burst Fractures | 195 | ||
| Spinous Process Fractures | 195 | ||
| Indications for Referral | 195 | ||
| Initial Treatment | 196 | ||
| Prehospital Care | 196 | ||
| Emergent Care | 196 | ||
| Follow-up Care | 196 | ||
| Return to Work or Sports | 196 | ||
| Cervical Spine Fractures (Pediatric) | 196 | ||
| Anatomic Considerations | 196 | ||
| Mechanism of Injury | 196 | ||
| Clinical Presentation | 197 | ||
| Imaging | 197 | ||
| Fracture Patterns | 198 | ||
| Spinal Cord Injury without Radiographic Abnormality | 198 | ||
| Odontoid Fracture | 198 | ||
| True C2 on C3 Subluxation | 199 | ||
| Wedge Compression Fractures | 199 | ||
| Indications for Referral | 199 | ||
| Initial Treatment | 199 | ||
| Follow-up Care | 200 | ||
| Complications | 200 | ||
| Return to Sports | 200 | ||
| Thoracolumbar Spine Fractures (Adult) | 200 | ||
| Anatomic Considerations | 200 | ||
| Compression Fractures | 201 | ||
| Mechanism of Injury | 201 | ||
| Clinical Presentation | 201 | ||
| Imaging | 201 | ||
| Indications for Referral | 202 | ||
| Initial Treatment | 202 | ||
| Follow-up Care | 203 | ||
| Return to Work or Sports | 203 | ||
| Spinous Process and Transverse Process Fractures | 203 | ||
| Burst Fractures | 204 | ||
| Thoracolumbar Spine Fractures (Pediatric) | 204 | ||
| Anatomic Considerations | 204 | ||
| Mechanism of Injury | 204 | ||
| Clinical Presentation | 204 | ||
| Imaging | 204 | ||
| Indications for Orthopedic Referral | 205 | ||
| Treatment | 205 | ||
| Complications | 205 | ||
| Return to Sports | 205 | ||
| Spondylolysis | 205 | ||
| Mechanism of Injury | 205 | ||
| Clinical Presentation | 206 | ||
| Imaging | 206 | ||
| Indications for Orthopedic Referral | 207 | ||
| Treatment | 208 | ||
| Complications | 208 | ||
| Return to Sports | 208 | ||
| Nontraumatic Thoracolumbar Fractures | 208 | ||
| Osteoporotic Fractures | 208 | ||
| Fracture Risk Assessment | 208 | ||
| Mechanism of Injury | 209 | ||
| Clinical Presentation | 209 | ||
| Imaging | 209 | ||
| Indications for Orthopedic Referral | 209 | ||
| Initial Treatment | 209 | ||
| Follow-up Care | 209 | ||
| Complications | 210 | ||
| Tumors | 210 | ||
| Pediatric Considerations | 210 | ||
| Vertebral Osteomyelitis | 211 | ||
| Clinical Presentation and Laboratory Studies | 211 | ||
| Imaging | 211 | ||
| Treatment | 211 | ||
| Pediatric Considerations | 212 | ||
| References | 212 | ||
| 11 Femur and Pelvis Fractures | 214 | ||
| Femoral Neck Fractures | 214 | ||
| Anatomic Considerations | 214 | ||
| Mechanism of Injury | 214 | ||
| Clinical Presentation | 214 | ||
| Imaging | 215 | ||
| Indications for Orthopedic Referral | 217 | ||
| Initial Treatment | 217 | ||
| Follow-up Care | 217 | ||
| Complications | 218 | ||
| Intertrochanteric Fractures | 218 | ||
| Anatomic Considerations | 218 | ||
| Mechanism of Injury | 218 | ||
| Clinical Presentation | 218 | ||
| Imaging | 218 | ||
| Indications for Orthopedic Referral | 219 | ||
| Initial Treatment | 219 | ||
| Follow-up Care | 219 | ||
| Complications | 219 | ||
| Pediatric Considerations | 219 | ||
| Trochanteric Fractures | 220 | ||
| Femoral Shaft Fractures | 221 | ||
| Anatomic Considerations | 221 | ||
| Mechanism of Injury | 221 | ||
| Clinical Presentation | 221 | ||
| Imaging | 222 | ||
| Initial Treatment | 222 | ||
| Follow-up Care | 222 | ||
| Complications | 223 | ||
| Pediatric Considerations | 223 | ||
| Stress Fractures of the Femur | 224 | ||
| Femoral Neck Stress Fractures | 224 | ||
| Clinical Presentation | 224 | ||
| Imaging | 224 | ||
| Indications for Orthopedic Referral | 224 | ||
| Treatment | 224 | ||
| Femoral Shaft Stress Fractures | 225 | ||
| Clinical Presentation | 225 | ||
| Imaging | 225 | ||
| Treatment | 226 | ||
| Hip Dislocations | 226 | ||
| Pelvic Fractures | 228 | ||
| Anatomic Considerations | 228 | ||
| Mechanism of Injury | 229 | ||
| Clinical Presentation | 230 | ||
| Imaging | 230 | ||
| Indications for Orthopedic Referral | 230 | ||
| Initial Treatment | 231 | ||
| Emergent Treatment | 231 | ||
| Follow-up Care | 231 | ||
| Unstable Fractures | 231 | ||
| Stable Fractures | 231 | ||
| Complications | 231 | ||
| Pediatric Considerations | 231 | ||
| Avulsion Fractures | 231 | ||
| Acetabular Fractures | 232 | ||
| References | 233 | ||
| 12 Patellar, Tibial, and Fibular Fractures | 234 | ||
| Patellar Fractures And Dislocations | 234 | ||
| Anatomic Considerations | 234 | ||
| Mechanism of Injury | 234 | ||
| Clinical Presentation | 235 | ||
| Imaging | 235 | ||
| Indications for Orthopedic Referral | 236 | ||
| Initial Treatment | 236 | ||
| Follow-up Care | 236 | ||
| Return to Work or Sports | 237 | ||
| Complications | 237 | ||
| Pediatric Considerations | 238 | ||
| Patellar Dislocation | 238 | ||
| Mechanism of Injury | 238 | ||
| Clinical Presentation | 238 | ||
| Reduction Maneuver | 239 | ||
| Imaging | 239 | ||
| Indications for Orthopedic Referral | 239 | ||
| Initial Treatment | 239 | ||
| Follow-up Care | 239 | ||
| Complications | 239 | ||
| Pediatric Considerations | 239 | ||
| Tibial Fractures | 239 | ||
| Anatomic Considerations | 239 | ||
| Tibial Plateau Fractures | 240 | ||
| Mechanism of Injury | 240 | ||
| Clinical Presentation | 240 | ||
| Imaging | 241 | ||
| Indications for Orthopedic Referral | 241 | ||
| Initial Treatment | 241 | ||
| Follow-up Care | 243 | ||
| Return to Work or Sports | 243 | ||
| Complications | 243 | ||
| Pediatric Considerations (Proximal Tibia) | 243 | ||
| Tibial Tubercle | 243 | ||
| Tibial Spine | 244 | ||
| Tibial Shaft Fractures | 244 | ||
| Mechanism of Injury | 244 | ||
| Clinical Presentation | 245 | ||
| Compartment Syndrome | 245 | ||
| Imaging | 246 | ||
| Indications for Orthopedic Referral | 246 | ||
| Emergent Referral | 246 | ||
| Referral Within 1 to 2 days | 246 | ||
| Initial Treatment | 247 | ||
| Follow-up Care | 247 | ||
| Return to Work or Sports | 248 | ||
| Complications | 248 | ||
| Pediatric Considerations | 248 | ||
| Toddler’s Fracture | 252 | ||
| Stress Fractures of the Tibia | 252 | ||
| Clinical Presentation | 252 | ||
| Imaging | 252 | ||
| Indications for Orthopedic Referral | 253 | ||
| Initial Treatment | 253 | ||
| Follow-up Care | 253 | ||
| Return to Work or Sports | 254 | ||
| Fractures of the Shafts of the Tibia and Fibula | 254 | ||
| Fibular Fractures | 254 | ||
| Anatomic Considerations | 254 | ||
| Mechanism of Injury | 254 | ||
| Clinical Presentation | 255 | ||
| Imaging | 255 | ||
| Indications for Orthopedic Referral | 255 | ||
| Initial Treatment | 255 | ||
| Follow-up Care | 256 | ||
| Return to Work or Sports | 256 | ||
| Complications | 256 | ||
| Pediatric Considerations | 256 | ||
| Stress Fractures of the Fibula | 257 | ||
| References | 257 | ||
| 13 Ankle Fractures | 258 | ||
| Ankle Fractures (Adult) | 258 | ||
| Anatomic Considerations | 258 | ||
| Classification | 259 | ||
| Mechanism of Injury | 259 | ||
| Clinical Presentation | 259 | ||
| Imaging | 262 | ||
| Indications for Orthopedic Referral | 263 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 263 | ||
| Nonemergent Referral (Within a Few Days from Injury) | 263 | ||
| Initial Treatment | 266 | ||
| Follow-up Care | 267 | ||
| Isolated Nondisplaced Lateral Malleolar Fractures | 267 | ||
| Isolated Nondisplaced Medial or Posterior Malleolar Fractures | 268 | ||
| Distal Fibular Shaft Fractures | 268 | ||
| Rehabilitation | 268 | ||
| Return to Work or Sports | 268 | ||
| Complications | 269 | ||
| Ankle Fractures (Pediatric) | 269 | ||
| Classification | 269 | ||
| Distal Tibial Fractures | 270 | ||
| Anatomic Considerations | 270 | ||
| Mechanism of Injury | 270 | ||
| Clinical Symptoms and Signs | 270 | ||
| Radiographic Findings | 270 | ||
| Indications for Orthopedic Referral | 272 | ||
| Treatment | 272 | ||
| Type I and II Fractures | 272 | ||
| Complications | 272 | ||
| Distal Fibular Fractures | 272 | ||
| Ankle Dislocation | 274 | ||
| Posterior Dislocation | 274 | ||
| Anterior Dislocation | 274 | ||
| Lateral Dislocation | 274 | ||
| Treatment | 274 | ||
| Reduction Maneuvers | 274 | ||
| References | 275 | ||
| 14 Calcaneus and Other Tarsal Fractures | 276 | ||
| Calcaneus Fractures (Adult) | 276 | ||
| Anatomic Considerations | 276 | ||
| Imaging | 276 | ||
| Classification | 278 | ||
| Extraarticular Fracture: Anterior Process | 279 | ||
| Mechanism of Injury | 279 | ||
| Clinical Presentation | 279 | ||
| Imaging | 279 | ||
| Indications for Orthopedic Referral | 280 | ||
| Initial Treatment | 280 | ||
| 15 Metatarsal Fractures | 299 | ||
| Fractures of the Metatarsal Shafts | 299 | ||
| Anatomic Considerations | 299 | ||
| Mechanism of Injury | 299 | ||
| Clinical Presentation | 299 | ||
| Imaging | 300 | ||
| Indications for Orthopedic Referral | 300 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 300 | ||
| Early Referral or Consultation (Within a Few Hours) | 300 | ||
| Nonemergent Referral (Within a Few Days of Injury) | 300 | ||
| Initial Treatment | 301 | ||
| Nondisplaced Fractures | 301 | ||
| Displaced Fractures | 302 | ||
| Follow-up Care | 302 | ||
| Nondisplaced Fractures | 302 | ||
| Displaced Fractures after Reduction | 303 | ||
| Return to Work or Sports | 304 | ||
| Complications | 304 | ||
| Pediatric Considerations | 304 | ||
| Stress Fractures of the Metatarsal Shafts | 306 | ||
| Pediatric Considerations | 306 | ||
| Proximal Fractures of the First through Fourth Metatarsals | 306 | ||
| Anatomic Considerations | 306 | ||
| Mechanism of Injury | 306 | ||
| Clinical Presentation | 307 | ||
| Imaging | 308 | ||
| Lisfranc Joint Dislocation | 308 | ||
| Indications for Orthopedic Referral | 309 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 309 | ||
| Early Referral or Consultation (Within a Few Hours) | 309 | ||
| Nonemergent Referral (Within a Few Days of Injury) | 310 | ||
| Treatment | 310 | ||
| Return to Work or Sports | 310 | ||
| Complications | 310 | ||
| Pediatric Considerations | 310 | ||
| Fractures of the Proximal Fifth Metatarsal | 311 | ||
| Anatomic Considerations | 311 | ||
| Avulsion Fractures of the Styloid | 312 | ||
| Mechanism of Injury | 312 | ||
| Clinical Presentation | 312 | ||
| Imaging | 312 | ||
| Indications for Orthopedic Referral | 313 | ||
| Initial Treatment | 313 | ||
| Return to Work or Sports | 313 | ||
| Complications | 313 | ||
| Pediatric Considerations | 313 | ||
| Fractures of the Metaphyseal–Diaphyseal Junction | 314 | ||
| Mechanism of Injury | 314 | ||
| Clinical Presentation | 314 | ||
| Imaging | 314 | ||
| Indications for Orthopedic Referral | 314 | ||
| Initial Treatment | 315 | ||
| Follow-Up Care | 315 | ||
| Return to Work or Sports | 316 | ||
| Complications | 316 | ||
| Pediatric Considerations | 316 | ||
| Stress Fracture of the Fifth Metatarsal Diaphysis | 316 | ||
| Mechanism of Injury | 316 | ||
| Clinical Presentation | 317 | ||
| Imaging | 317 | ||
| Indications for Orthopedic Referral | 317 | ||
| Initial Treatment | 317 | ||
| Follow-up Care | 317 | ||
| Return to Work or Sports | 318 | ||
| Complications | 318 | ||
| Pediatric Considerations | 318 | ||
| References | 318 | ||
| 16 Toe Fractures | 319 | ||
| Toe Fractures | 319 | ||
| Anatomic Considerations | 319 | ||
| Mechanism of Injury | 319 | ||
| Clinical Presentation | 319 | ||
| Imaging | 319 | ||
| Indications for Orthopedic Referral | 319 | ||
| Initial Treatment | 320 | ||
| Nondisplaced Fractures | 320 | ||
| Displaced Fractures: Closed Reduction Technique | 321 | ||
| Treatment of Open Distal Phalanx Toe Fractures | 321 | ||
| Follow-up Care | 322 | ||
| Return to Work or Sports | 322 | ||
| Complications | 323 | ||
| Pediatric Considerations | 323 | ||
| Toe Dislocations | 323 | ||
| Sesamoid Fractures | 323 | ||
| Mechanism of Injury | 323 | ||
| Clinical Presentation | 324 | ||
| Imaging | 324 | ||
| Indications for Orthopedic Referral | 324 | ||
| Treatment | 324 | ||
| References | 326 | ||
| 17 Facial and Skull Fractures | 327 | ||
| Nasal Fractures | 327 | ||
| Anatomic Considerations | 327 | ||
| External Nose | 327 | ||
| Nasal Septum and Surrounding Structures | 327 | ||
| Mechanism of Injury | 329 | ||
| Clinical Presentation | 329 | ||
| Imaging | 330 | ||
| Indications for Referral | 330 | ||
| Emergent Referral (Within 30 to 60 Minutes) | 330 | ||
| Nonemergent Referral (Within Several Days) | 330 | ||
| Initial Treatment | 330 | ||
| Epistaxis | 330 | ||
| Septal Hematoma | 331 | ||
| Isolated, Simple Nasal Bone Fractures | 331 | ||
| Informed Consent Before Closed Reduction | 331 | ||
| Indications and Technique for Closed Reduction of Isolated, Simple Nasal Fractures | 332 | ||
| Follow-up Care | 332 | ||
| Return to Work or Sports | 333 | ||
| Complications | 333 | ||
| Pediatric Considerations | 333 | ||
| Fractures of Other Facial Bones | 334 | ||
| Anatomic Considerations | 334 | ||
| Mechanism of Injury | 334 | ||
| Clinical Presentation | 334 | ||
| Midface | 334 | ||
| Orbital Floor (Blowout) Fractures | 335 | ||
| Imaging | 336 | ||
| Mandible | 336 | ||
| Other Facial Bones | 336 | ||
| Classification | 337 | ||
| Indications for Referral | 337 | ||
| Emergent Referral (30 to 60 Minutes Depending on the Stability of the Patient) | 337 | ||
| Initial Treatment | 337 | ||
| Follow-up Care | 338 | ||
| Return to Work or Sports | 338 | ||
| Complications | 338 | ||
| Pediatric Considerations | 338 | ||
| Skull Fractures | 338 | ||
| Anatomic Considerations | 338 | ||
| Mechanism of Injury | 339 | ||
| Clinical Presentation | 339 | ||
| Imaging | 339 | ||
| Indications for Referral | 339 | ||
| Initial Treatment | 339 | ||
| Complications | 340 | ||
| Return to Work or Sports | 340 | ||
| Pediatric Considerations | 340 | ||
| References | 340 | ||
| 18 Rib Fractures | 341 | ||
| Anatomic Considerations | 341 | ||
| Mechanism of Injury | 341 | ||
| Rib Fractures after Trauma | 341 | ||
| Clinical Presentation | 341 | ||
| Imaging | 341 | ||
| Indications for Orthopedic Referral | 342 | ||
| Initial Treatment. | 343 | ||
| Emergent Treatment | 343 | ||
| Nonemergent Treatment | 343 | ||
| Definitive Treatment | 344 | ||
| Return to Work or Sports | 344 | ||
| Complications | 344 | ||
| Pediatric Considerations | 344 | ||
| Stress Fractures of the Ribs | 345 | ||
| Cough-Induced Stress Fracture | 345 | ||
| Sports-Related Fracture | 345 | ||
| References | 345 | ||
| Appendix (CASTING AND SPLINTING) | 346 | ||
| General Principles about Splinting and Casting | 346 | ||
| Fiberglass Splint Rolls | 346 | ||
| Creating Your Own Splint | 346 | ||
| Casts | 347 | ||
| Cast Removal | 347 | ||
| Short-Arm Cast CPT 29075 | 348 | ||
| Indications. | 348 | ||
| Advantages. | 348 | ||
| Disadvantages. | 348 | ||
| Materials. | 348 | ||
| Instructions | 348 | ||
| Short-Arm Thumb Spica Cast CPT 29075 | 352 | ||
| Indications. | 352 | ||
| Advantages. | 352 | ||
| Disadvantages. | 352 | ||
| Materials. | 352 | ||
| Instructions | 352 | ||
| Long Arm Cast CPT 29065 | 354 | ||
| Indications. | 354 | ||
| Advantages. | 354 | ||
| Disadvantages. | 354 | ||
| Note. | 354 | ||
| Materials. | 354 | ||
| Instructions | 354 | ||
| Long-Arm Thumb Spica Cast CPT 29065 | 357 | ||
| Indications. | 357 | ||
| Advantages. | 357 | ||
| Disadvantages. | 357 | ||
| Note. | 357 | ||
| Materials. | 357 | ||
| Instructions | 357 | ||
| Short-Leg Cast: Non–Weight Bearing (CPT 29405) and Weight Bearing (CPT 29425) | 360 | ||
| Indications. | 360 | ||
| Advantages. | 360 | ||
| Disadvantages. | 360 | ||
| Materials. | 360 | ||
| Instructions | 360 | ||
| Non–Weight Bearing | 360 | ||
| Add this Step for a Weight-Bearing Cast | 360 | ||
| Long-Leg Cast CPT 29345,355 or 365 | 362 | ||
| Indications. | 362 | ||
| Advantages. | 362 | ||
| Disadvantages. | 362 | ||
| Materials. | 362 | ||
| Instructions | 362 | ||
| Ulnar Gutter Splint CPT 29125 | 364 | ||
| Indications. | 364 | ||
| Advantages. | 364 | ||
| Materials. | 364 | ||
| Instructions | 364 | ||
| Upper Extremity Sugar Tong Splint CPT Code 29125 | 366 | ||
| Indications. | 366 | ||
| Advantages. | 366 | ||
| Disadvantages. | 366 | ||
| Note. | 366 | ||
| Materials. | 366 | ||
| Instructions | 366 | ||
| Thumb Spica Sugar Tong Splint CPT Code 29105 | 367 | ||
| Indications. | 367 | ||
| Advantages. | 367 | ||
| Disadvantages. | 367 | ||
| Materials. | 367 | ||
| Instructions | 367 | ||
| Lower Extremity Splint (Three-Sided Immobilization) CPT 29505 | 369 | ||
| Indications. | 369 | ||
| Advantages. | 369 | ||
| Materials. | 369 | ||
| Instructions | 369 | ||
| index | 373 | ||
| A | 373 | ||
| B | 373 | ||
| C | 373 | ||
| D | 374 | ||
| E | 375 | ||
| F | 375 | ||
| G | 377 | ||
| H | 377 | ||
| I | 377 | ||
| J | 378 | ||
| K | 378 | ||
| L | 378 | ||
| M | 378 | ||
| N | 380 | ||
| O | 380 | ||
| P | 380 | ||
| R | 381 | ||
| S | 382 | ||
| T | 383 | ||
| U | 384 | ||
| V | 384 | ||
| W | 384 |