Acute Orthopedics

&
Basic Musculoskeletal Imaging
PART 8
Clinical Medicine III
PAST 543
Summer 2015

X-RAY REVIEW #1
Linda Metzger, BS, MPA, PA-C

HAND

18 y/o male
What is the diagnosis?
How do you describe what
you see?

21 y/o male, punched a tree

Hematoma block (see video).

Reduction while cast set.
Patient sighed & said that it felt better!

Scaphoid Fx
3 different people

WRIST

6 y/o RHD female fell off monkey bars

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6 y/o RHD male fell off monkey bars

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6 y/o post-reduction

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13 y/o boy, fell, hurt L wrist

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13 y/o boy, one year later

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HISTORY:
Patient is a 15-year-old right-hand-dominant male. Patient was at the beach and was using his skin board. He
fell and injured his left wrist. Patient is here with both parents. The patient has a twin sister.
PHYSICAL EXAMINATION:
Patient's left wrist does not have any obvious deformity, bruising or swelling. Patient is neurovascularly intact.
He has no tenderness to his elbow.
Patient is extremely apprehensive and jumpy when I get near him. Patient did not handle the reduction very
well and got dizzy. After about 5 minutes, he felt well enough to sit up and the dizziness eventually resolved.
Patient's father stayed with him throughout the process.
X-RAY:
Left distal radial and distal ulna fractures, metaphyseal. The radius has approximately a 24 degree dorsal
angulation.
ASSESSMENT:
Left distal radius and distal ulna fractures.
PLAN:
1. I had a lengthy discussion with both parents about his injury and conservative treatment versus
manipulation. Both parents agreed to closed reduction with manipulation, but refused the hematoma block.
2. Patient's parents understand that even with the successful reduction today that the reduction can be lost,
necessitating another reduction or possible reduction under a general anesthesia.
3. Patient was hung in finger traps with 8 pounds for 5 minutes. After this was removed, the closed reduction
and manipulation was performed. The patient placed into left long-arm cast with wrist flexion and slight ulnar
deviation. Postreduction x-ray showed improvement of alignment.
4. Patient has Tylenol No. 3 at home for pain control. The patient will follow up in 1 week for x-ray, 2 views,
15 left
wrist in cast.

15 y/o male day one

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15 y/o male post reduction & casting.

Swore at me, tried to kick me, cried & almost passed out.
Family cancelled trip to Hawaii.

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15 y/o male one month later

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15 y/o male two months later

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ELBOW

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46 y/o RHD male

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86 y/o female, doesnt remember falling.

Prior sx

Post22
sx

HUMERUS

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3 y/o RHD female fell

twice in 6 days
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3 y/o RHD female 6 weeks later

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SHOULDER

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68 y/o female day one & 6 weeks later

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CLAVICLE

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73 y/o male slipped off stepstool while washing his car.

Day of injury.

One month later.

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PELVIS

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HIP

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FEMUR

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63 y/o diabetic male

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KNEE

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56 y/o morbidly obese female, needs to lose

110+ pounds before she can qualify for TKA.

Also, she has horrible dental hygiene

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36

37

83 y/o female fell onto both knees

Not splinted by urgent care!

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LAT. View patella fx

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TIB/FIB

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ANKLE

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FOOT

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12 y/o female jumped off roof aiming for pool, missed, hit edge!
This is her left heel, needs sx!
Her right heel, got casted!
What else do you need to remember to x-ray?

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12 y/o female with B heel fx

L-spine x-rays for all heel fx!

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64 y/o male, running, shifted

onto uneven driveway to avoid
another runner with a dog.

Treatment?

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SLC or boot.
Non-weight bearing for 1-3 months.

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16 y/o female, kicked the back of a friends foot.

52 y/o smoker & alcoholic male tripped in his flip flops

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Digital block, reduction with ball point pen, buddy tape toes #3-#5

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52 y/o smoker
& alcoholic
male tripped in
his flip flops

AP view
left foot

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Oblique view
left foot

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Lateral view
left foot

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Physician Assistants More Than Double in a Decade

Larry Hand (August 12, 2014)

The number of certified physician assistants (PAs) grew 219% from 2003 to 2013,
almost 6% alone during the last year of that decade, according to the 2013
Statistical Profile of Certified Physician Assistants published online by the National
Commission on Certification of Physician Assistants (NCCPA). The number of
certified PAs stood at 95,583 across the United States at the end of 2013, compared
with 90,227 in 2012 and 43,500 in 2003. PAs practice in all 50 states and the District
of Columbia, according to the NCCPA, the only certifying organization for PAs in the
country. The organization analyzed data primarily from responses provided by
almost 80% of certified PAs in their personal profiles on a portal of the NCCPA Web
site.
Multiple Job Offers
Most PAs (66%) are women, and 62.2% of them are under 40 years old, while
37.6% of men are under 40 years old. PAs are overwhelmingly (85.6%) white, and
most (66.2%) have earned master's degrees. While 3.4% of PAs speak 2 or more
languages, most who communicate with patients in a non-English language speak
in Spanish.

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If nothing else, remember this

Join CAPA
Join AAPA

Do not complete informed consents in your non-fluent language.

If asked, dont lie that its your first time

Heel fx? Look stellar & ask for L-spine x-rays.

Humerus fx? Check radial nerve function prior & post splint.

Fracture-dislocation? Always attempt to relocate, then splint.

Fingernail/toenail avulsion? Dont throw nail away, suture back onto finger/toe tip.

No fx seen on x-ray, but elbow extremely swollen? Get MRI.

Kids heal fastdont delay ortho referral

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