By Richard Park Sassan Naderi
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Extra resources for Intensive Review for the Emergency Medicine Qualifying Examination (Intensive Review Book)
Plain radiographs i. Review—fractures and dislocations described by the distal segment relative to proximal ii. Posterior dislocation would appear with humerus anterior to olecranon 4. Management a. Early reduction with analgesia and muscle relaxant b. Gentle traction with elbow at ~30 degrees flexion c. May use modified Stimson technique (shoulder relocation technique) with patient lying prone and weight attached to flexed elbow at 30 degrees 5. Complications a. Anterior dislocations have higher incidence of complications b.
Signet ring sign—rotary subluxation results in shadowing of distal scaphoid onto body of scaphoid d. Management i. Thumb spica and orthopedic referral ii. Surgery usually indicated e. Complications i. Carpal bone instability ii. Arthritis 2. Lunate and perilunate dislocations a. Mechanism i. High-energy injury as in fall from height ii. Hyperextension and ulnar deviation injury as in FOOSH iii. Spectrum of injury beginning with scapholunate dissociation to perilunate dislocation to lunate dislocation a) The capitate is dislocated dorsally (perilunate dislocation) and with higher energy injuries, rebounds to knock lunate in volar direction (lunate dislocation) b.
Fall onto outstretched arm leads to posterior elbow dislocation (majority) b. Direct trauma to olecranon may result in anterior dislocation 2. Symptoms and signs a. Pain, swelling, deformity b. Posterior dislocation—elbow in flexion at 45 degrees c. Anterior dislocation—upper arm appears shortened and held in supination and full extension 3. Diagnosis a. Plain radiographs i. Review—fractures and dislocations described by the distal segment relative to proximal ii. Posterior dislocation would appear with humerus anterior to olecranon 4.