September 28, 2020

Background: FOOSH injuries, or falls onto outstretched hands, are a common presentation to the emergency department, and can frequently result in scaphoid fractures.  In fact, scaphoid fractures “account for 90% of all carpal fractures and 2-7% of all fractures” (Dias).  The most common location for a scaphoid fracture is within the scaphoid waist.  As with any fracture, in treating a scaphoid fracture, the goal is to stabilize fracture fragments in alignment to allow healing.  For scaphoid fractures, this can be accomplished with either casting to immobilize the wrist or by placing a screw through the fracture.  Traditional treatment strategy usually included plaster cast immobilization for 6-10 weeks, with operative fixation only for the roughly 10% of cases in which healing was unsatisfactory.  In recent years, however, there has been a trend toward early surgical intervention.  This trend results in higher costs and more invasive procedures, but is thought to speed recovery, allowing for earlier return to normal function.  In 2018, a systematic review and meta-analysis (14 trials with 765 patients) by Li et al compared surgical vs. non-surgical treatment of scaphoid waist fractures showed “no statistical difference in patient satisfaction, pain, and The Disability of the Arm, Shoulder, and Hand scores between surgical treatment and nonsurgical treatment.” Due to the variable quality of the data analyzed, the authors recommended further high-quality studies (Li).  

September 7, 2020

Definition: Medial or posterior slippage of the femoral capital epiphysis relative to the metaphysis

Epidemiology:

  • Classic patient group: overweight adolescent boys
    • Over 80% of SCFE involves children with a BMI > 95th percentile (Manoff 2005).
    • Average age of onset: 12 years old
  • Bilateral SCFE is fairly common
    • 23% will have contralateral disease at the time of initial presentation, despite only complaining of unilateral pain (Hagglund 1988, Loder 1993).
    • Up to 60% of patients will go on to develop bilateral SCFE in their lifetime
    • 88% of subsequent slips occur within 18 months of diagnosing the first slip
  • Influenced by bone maturation, strength, and weight mismatch.
  • SCFE has also been associated with endocrine disorders such as hypothyroidism, hypogonadism, pan-hypopituitarism, but this is not as common.

July 22, 2020

Take Home Points
  • Spinal Epidural Abscess may present insidiously and patients often lack the classic triad of fever, back pain and neurologic symptoms
  • Empiric Antibiotics should cover Staphylococcus (including MRSA) and Gram negative Bacilli
  • All patients with clinical suspicion require rapid evaluation with MRI as the diagnostic study of choice
  • Although not all patients will go to the operating room, surgical consult (Neurosurgery or Orthopedics) should be obtained emergently

June 1, 2020

Background: Humeral shaft fractures are commonly seen in the Emergency Department and emergency management is relatively straightforward: assess for other trauma, assess for radial nerve injury, analgesia, sling or functional bracing and follow up with orthopedics. However, there are debates in management specifically around operative vs non-operative management. The non-operative approach has been the standard but, the rate of surgery has markedly risen in the last decade (Schoch 2017). Operative management appears to reduce the risk of nonunion significantly but, comes with other risks including infections and iatrogenic radial nerve injuries. In the absence of high-quality evidence, marked practice variation persists.

November 9, 2017

This year ACEP 2017 took place in Washington D.C. from Oct. 29th – Nov 1st, 2017.   There were lots of amazing speakers and topics as was evidenced by the eruption of everyone’s twitter feeds with the #ACEP17 hashtag.  I was fortunate enough to attend this amazing conference and approached by several attendees if I would put together a list of my favorite pearls from this conference.  I decided to put a top 10 list together, in no particular order.
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