Orthopedics

HOME BASE:

Ortho library just next to the Peds EM offices on the A level.


CALL:

EM1 is called to ED for all ortho consults including reductions and can assist in reductions with ortho senior, write consult documentation, etc.

EM1 is called to ED for hand consults (in addition to hand fellow/ortho senior) during the week ortho covers hand. Ortho also does spine call on some days. They can assist in documentation, and procedure if within their scope of care.

EM1 can cover floor calls while on their shift. The residents don't expect you to do this though.


SCHEDULE:

Monday, Tuesday, Thursday, Friday, Saturday, Sunday 3p-3a

Wednesday OFF

The schedule is negotiable. In general if you want a different day off or an extra day off they are fine with it.

The schedule may also vary if there is more than one EM resident on the service for a given month. Work out the schedule with your senior.


TYPICAL DAY:

Either show up at 3 pm or wait for the first consult call if you live close by. If you are not in the building when certain procedures need to be done, though, you will miss them (like dislocations which require immediate reduction).

For the first 3 hours or so, the ortho PGY-1 and you will overlap your schedule, so you may be less occupied but it may also be busy and they may need your help. If you aren't busy it is a great time to read or study.


PAPERWORK:

Consult note--they can use if for an H&P if the patient is admitted. Steal smart phrases from your senior.

The PGY-2 Will co-sign your note. The attendings generally will not staff the note from that night, so sign your note with no cosigner and the PGY-2 will take over the note and addend it.

STUFF TO REVIEW:

Neuro-vascular exam including:

Upper extremity peripheral nerve motor:

  • Median: OK sign and/or thumb apposition
  • Ulnar: finger spread
  • Radial: thumbs up

Lower extremity peripheral nerve motor ("TIPPED"):

  • Tibial: ankle inversion and plantarflexion
  • Peroneal: ankle eversion and dorsiflexion

Upper and lower extremity anatomy including innervation, blood supply, muscles, bones. Use the Anatomy for Emegency Physicians videos from Emergency Medicine Ireland.


Common fractures/dislocations and their management including:

  1. Forearm fractures
  2. Pediatric supracondylar fractures
  3. Humerus fractures
  4. Boxer's fractures
  5. Shoulder dislocations
  6. Elbow dislocations
  7. Finger dislocations
  8. Hip dislocations
  9. Knee dislocations
  10. Patella dislocations


Splinting including:

  1. Sugar tong
  2. Ulnar gutter
  3. Thumb spica
  4. Posterior lower leg
  5. Lower leg 3-sided splint


Open vs closed fracture management

You may also get some practice suturing hand wounds, arthrocentesis or loading joints to rule out arthrotomy in trauma.


PEARLS:

​OrthoBullets

Normals for Age

Normal Variants


The seniors vary in their teaching and comfort level for walking you through procedures. If you push to do more you will get lots of reductions, splints, nail bed repairs, etc.


Hanging out in the ortho library rather than the ED library or at home will increase the numbers of procedures you get.


​It's a wonderful rotation as there is essentially no scut work. The only time you work is when it's EM relevant.