Tag Archives | Orthopaedics

Everything you could possibly want or need to know about shoulder dislocation.

It had to happen at some point.  So many reduction techniques, so many eponymous names, which ones work, which ones don’t, what’s the evidence for this technique vs that technique, my old boss showed me  this neat trick, works every time… Nitrous vs midaz vs Propfol vs accupuncture vs hypnosis, do you use a towel, a sheet or a foot in the axilla? Do you need to learn scapular manipulation or Orthopaedic Registrar manipulation?

Well now you can forget everything you’ve ever heard about shoulder dislocation and start from scratch. Check out shoulderdislocation.net, the best, most comprehensive, beatifully laid out site on shoulder dislocation you’ve ever seen. 13 videos and loads of articles on different reduction techniques, aftercare advice and more. For those just starting to learn about reducing shoulders, it will be invaluable, but there’s plenty there for the experts amongst us as well.

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Send them to the gallows! Paediatric femur fracture.

A disturbing case I saw recently of a 6 month old baby who’s toddler brother was jumping on the bed and landed across the baby’s leg – snapping the femur clean in half.
paed_femur
Disturbing on many levels, including the obvious “is that really how it happened” question that I felt obliged to ask, but deferred due to the level of parental distress; disturbing as I could easily see my 2.5yr old daughter doing the same thing to my 10 month old son, (how would I explain that, I wondered…) and my inability to think of adequate analgesic options quickly (we ended up with IV fentanyl, after consulting the anaesthetist, and after I failed the IV twice and the serendipitous Paeds Reg walking by helped me get IV access), and disturbing because I assumed the baby would go straight to theatre, wrongly explained this to the parents, and then was educated by the Ortho team that they actually manage these in traction – in a device disturbingly called “gallows traction”.
gallows
Thankfully a rare enough injury, but thought I’d share the management tip in case you ever see one, as the management is non-operative in younger patients, (traction if displaced, spica if undisplaced), operative in older kids.

Here’s a nice summary over at Wheeless Online.

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