Foreword Orthopedic Emergencies
Amal Mattu, MD Consulting Editor
Emergency orthopedics is an integral part of the practice of emergency medicine. On a routine shift this past week in the emergency department (ED), I cared for two patients who slipped on ice and sustained ankle fractures, one patient with a shoulder dislocation that occurred while he was playing basketball, an elderly patient with a spontaneous dislocation of his prosthetic hip, and another elderly patient with a hip fracture after she was involved in a motor vehicle accident. These patients were in addition to the handful of other patients with joint sprains and overuse injuries from shoveling snow, slips and falls, or manual labor. I finished the shift caring for a patient with a boxer’s fracture from an altercation with another patron in a bar. Had it been summertime, the injuries would mostly have been similar, though perhaps greater in number and with more sports-related mechanisms rather than snow and ice associations. Despite the frequency with which we see orthopedic emergencies in the ED, it seems that many training programs are often deficient in teaching the proper skills to deal with these conditions. There is always much greater emphasis during training on high-profile conditions such as multisystem trauma, acute myocardial infarction, sepsis, stroke, appendicitis, acute respiratory failure, and so on. The irony is that all these aforementioned conditions are less common than orthopedic emergencies. They also require admission, which, therefore, allows care to be passed on to other physicians. Many orthopedic emergencies, on the other hand, allow the emergency physician to “treat and street” the patients without requiring the immediate involvement of any consultants.IF the emergency physician is properly trained. Yet many emergency physicians, especially new graduates, are uncertain about diagnosing, treating, splinting, and providing dispositions for patients with orthopedic conditions. I’ll admit that at the beginning of my career, I fit that description as well, and thankfully my senior medical colleagues and physician assistants taught me more about emergency orthopedics during my first year as an attending than I learned in all of my residency training.
Emerg Med Clin N Am 33 (2015) xv–xvi http://dx.doi.org/10.1016/j.emc.2015.03.004 0733-8627/15/$ – see front matter Ó 2015 Published by Elsevier Inc.
For readers of Emergency Medicine Clinics of North America that have ever felt uncertain about how to care for some orthopedic conditions, as I did at the end of my training, this issue is written just for you. Guest editors Drs Della-Giustina and Goldflam have assembled an outstanding group of authors and they have created a fantastic curriculum in emergency orthopedics that deserves to be required reading for all emergency medicine trainees. The authors address every major and common bone and joint injury from the neck down to the foot. Detailed explanations of the proper examination techniques are provided as well as recommendations for reducing dislocations, for splinting, and for subsequent follow-up and care. They also provide a special article addressing some of the common pediatric orthopedic injuries. This issue of Emergency Medicine Clinics of North America represents an invaluable resource for routine clinical practice in emergency medicine. Experienced emergency physicians as well as emergency medicine trainees will benefit tremendously from the expertise provided in the pages that follow. Our thanks to the editors and authors of this excellent work! Amal Mattu, MD Department of Emergency Medicine University of Maryland School of Medicine Baltimore, MD 21201, USA E-mail address: [email protected]