Musculoskeletal Emergencies

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Musculoskeletal Emergencies ISBN: 978-1-4377-2229-1

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Library of Congress Cataloging-in-Publication Data

Musculoskeletal emergencies / [edited by] Bruce D. Browner, Robert Fuller.
â•…â•…â•… p. ; cm.
â•… Includes bibliographical references and index.
â•… ISBN 978-1-4377-2229-1 (hardcover : alk. paper)
╅ I.╇ Browner, Bruce D.╅ II.╇ Fuller, Robert, 1964-
â•… [DNLM:â•… 1.╇ Musculoskeletal System—injuries—Handbooks.â•… 2.╇ Emergencies—
Handbooks.â•… 3.╇ Orthopedic Procedures—methods—Handbooks.â•… 4.╇ Wounds and Injuries—
diagnosis—Handbooks.â•… WE 39]
â•… 617.4’7044—dc23
â•…â•… 2012018273

Executive Content Strategist: Dolores Meloni

Content Development Specialist: Julie Mirra
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Rachel E. McMullen
Design Direction: Steve Stave

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Last digit is the print number:â•… 9â•… 8â•… 7â•… 6â•… 5â•… 4â•… 3â•… 2â•… 1
To my wife, Barbara Thea Browner; to my children, Jeremy Todd Browner, Esq, Nina
Mikhelashvili Browner, MD, Nicole Browner Samuel, and Marc Aaron Samuel, Esq; and to
my grandsons, Benjamin Noah Browner, Zachary Myer Samuel, and Dylan Jethro Samuel.

In memory of my mother, Mona Alexander Browner.

In appreciation of support and encouragement from my father, Irwin Eric Browner, and
his wife, Adele Doris Browner, and my mother-in-law, Betty Appleman Jacowsky.

Bruce D. Browner

To my wife, Natalie Colemen-Fuller, PhD; to my children, Sarah Noel Fuller, Julia Coleman
Fuller, and Ellen Roselyn Fuller; and to my parents, Bob and Patricia Fuller.

Robert P. Fuller
 Contributors

Paul A. Anderson, MD Anat Cohen, MD

Professor Resident
Department of Orthopedic Surgery and Rehabilitation Pediatric Medicine
University of Wisconsin Case Western Reserve University
Madison, Wisconsin Cleveland, Ohio
Michael Aronow, MD Megan Cummings, MD
Associate Professor Emergency Medicine Residency Program
Department of Orthopaedic Surgery University of Connecticut
University of Connecticut School of Medicine Hartford, Connecticut
Farmington, Connecticut
Thomas M. DeBerardino, MD
Sarah Axler, MD Associate Professor
Resident Department of Orthopaedic Surgery
Department of Orthopaedic Surgery University of Connecticut Health Center
University of Connecticut Health Center Farmington, Connecticut
Farmington, Connecticut Team Physician, Orthopaedic Consultant
University of Connecticut Athletic Department
Nicholas A. Bontempo, MD Storrs, Connecticut
Resident
Department of Orthopaedic Surgery Andrew S. Erwteman, MD, DPT
University of Connecticut Health Center Resident
Farmington, Connecticut Department of Orthopaedic Surgery
University of Connecticut Health Center
John C. Brancato, MD Farmington, Connecticut
Assistant Professor
Departments of Pediatrics and Emergency Medicine Benjamin H. Evenchik, MD
University of Connecticut School of Medicine and Physician
Connecticut Children’s Medical Center Department of Emergency Medicine
Hartford, Connecticut University of Connecticut
Hartford, Connecticut
Robert T. Brautigam, MD, FACS
Interim Director, Neuroscience, Neurosurgery/Trauma Deborah Feldman, MD
Intensive Care Unit Assistant Professor
Department of Surgery Department of Obstetrics and Gynecology
Hartford Hospital University of Connecticut
Hartford, Connecticut Attending Perinatologist
Department of Obstetrics and Gynecology
Bruce D. Browner, MD, MS, FACS Hartford Hospital
Gray-Gossling Chair, Professor and Chairman Emeritus Hartford, Connecticut
Department of Orthopaedic Surgery
New England Musculoskeletal Institute Joel V. Ferreira, MD, MA
University of Connecticut Health Center Resident
Farmington, Connecticut; Department of Orthopaedic Surgery
Director of Orthopaedics University of Connecticut Health Center
Hartford Hospital Farmington, Connecticut
Hartford, Connecticut
Michael J. Finn, MD
Fernando Checo, MD Assistant Professor
Fellow, Spine Surgery Department of Neurosurgery
New England Baptist Hospital University of Colorado School of Medicine
Boston, Massachusetts Aurora, Colorado
 Contributors vii

Adam Fleit, MD Mark A. Harrast, MD

Contributors
Resident, Department of Orthopaedic Surgery Clinical Associate Professor
University of Connecticut Health Center Departments of Rehabilitation Medicine, Orthopaedics
Farmington, Connecticut and Sports Medicine
Director, Sports Medicine Fellowship
Alise Frallicciardi, MD Department of Rehabilitation Medicine
Assistant Professor Emergency Medicine University of Washington
Emergency Medicine Residency Program Seattle, Washington
University of Connecticut Health Center
Hartford Hospital Mitchell B. Harris, MD
Hartford, Connecticut Chief, Orthopaedic Trauma Service
Department of Orthopaedic Surgery
Jeremy Fried, MD Brigham and Women’s Hospital
Hartford Hospital Boston, Massachusetts
Hartford, Connecticut
Stanley A. Herring, MD
Robert P. Fuller, MD, FACEP Clinical Professor
Associate Professor Departments of Rehabilitation Medicine, Orthopaedics
Department of Emergency Medicine and Sports Medicine and Neurological Surgery
University of Connecticut School of Medicine; Director of Spine, Sports and Musculoskeletal Medicine
Emergency Medicine Clinical Chief of service UW Medicine Health System
John Dempsey Hospital University of Washington
Farmington, Connecticut Co-Medical Director, Seattle Sports Concussion Program
Richard Gannon, PharmD Harborview Medical Center and Seattle Children’s
Pharmacy Clinical Specialist–Pain Management Hospital
Department of Pharmacy Team Physician, Seattle Seahawks and Seattle Mariners
Hartford Hospital Seattle, Washington
Hartford, Connecticut Vijay Jayaraman, MD
Assistant Clinical Professor Fellow
School of Pharmacy Department of Trauma and Emergency Medicine
University of Connecticut Hartford Hospital
Storrs, Connecticut Hartford, Connecticut
Lauren Geaney, MD Ankita S. Kadakia, MD
Department of Orthopaedic Surgery Fellow
University of Connecticut Department of Infectious Diseases
Farmington, Connecticut University of Connecticut
Alex Goldstein, MD Farmington, Connecticut
Resident Richard Kamin, MD, FACEP
Department of Emergency Medicine EMS Program Director
University of Connecticut Health Center Assistant Professor
Farmington, Connecticut Department of Emergency Medicine
John Grady, MD University of Connecticut Health Center
Emergency Medicine Residency Program Farmington, Connecticut
University of Connecticut Alisa Kanfi, MD
Hartford, Connecticut Resident
John Greene, MD Department of Radiology
Associate Director Hartford Hospital
Women’s Health Hartford, Connecticut
Hartford Hospital Jaehon M. Kim, MD
Hartford, Connecticut Orthopaedic Surgery Resident
Residency Program Director and Associate Professor Harvard Combined Orthopaedics Residency Program
Department of Obstetrics and Gynecology Massachusetts General Hospital/Brigham and Women’s
University of Connecticut Hospital
Farmington, Connecticut Boston, Massachusetts
 viii Contributors

Mark C. Lee, MD Randy L. Olson, MD

Contributors

Assistant Professor Orthopaedic Surgeon

Department of Orthopaedics Dyersburg, Tennessee
Connecticut Children’s Medical Center
Hartford, Connecticut Michael Pensak, BS, MD
Post Graduate Student
Silas Marshall, MD Department of Orthopaedic Surgery
Department of Orthopaedics University of Connecticut Health Center
University of Connecticut Farmington, Connecticut
Farmington, Connecticut
Edward L. Pesanti, MD
Erin Maslowski, BD Professor
Departments of Physical Medicine and Rehabilitation and Department of Medicine
Sports Medicine Assistant Professor
Gundersen Lutheran Medical Center Department of Orthopaedic Surgery
La Crosse, Wisconsin University of Connecticut Health Center
Farmington, Connecticut
Augustus D. Mazzocca, MS, MD
Associate Professor Andrew W. Ritting, MD
Department of Orthopaedic Surgery Resident
University of Connecticut Health Center Department of Orthopaedic Surgery
Farmington, Connecticut University of Connecticut Health Center
Farmington, Connecticut
Michael A. Miranda, MD
Director of Orthopedic Trauma Craig M. Rodner, MD
Hartford Hospital Assistant Professor
Hartford, Connecticut; Department of Orthopaedic Surgery
Assistant Professor University of Connecticut Health Center
Department of Orthopedics Farmington, Connecticut
University of Connecticut
Farmington, Connecticut; Marinella M. Russell, RTR
Orthopedic Associates of Hartford Clinical Instructor
Hartford, Connecticut Allied Heath/Radiology
Hartford Hospital
Cristina Fe G. Mondragon, MD Hartford, Connecticut
Assistant Professor
ID Division, Department of Internal Medicine Laura Scordino, BS, MD
University of Connecticut Health Center Resident
Farmington, Connecticut Department of Orthopaedic Surgery
University of Connecticut
Douglas Montgomery, MD Farmington, Connecticut
Chief, Musculoskeletal Radiology
Department of Radiology Mark Shekhman, MD
Hartford Hospital Orthopaedic Surgeon
Hartford, Connecticut Hartford Clinical Associates
Hartford Hospital
Isaac Mussomeli Hartford, Connecticut
Medical Student
University of Connecticut Health Center Richard Sheppard, MD
Farmington, Connecticut Chief
Orthopedic Anesthesia
Michael N. Nakashian, MD, MA Hartford Hospital
Resident Hartford Anesthesiology Associates, Inc.
Orthopaedic Surgery Hartford, Connecticut
University of Connecticut
Farmington, Connecticut Nicole Silverstein, MD, FACP
Assistant Professor
Mary Norton, RT Department of Medicine
Department of Radiology University of Connecticut
Hartford Hospital Farmington, Connecticut
Hartford, Connecticut
Shawn Stapp, DO
Susan O’Brien, RT Chief Resident
Department of Radiology University of Connecticut Health Center
Hartford Hospital Farmington, Connecticut
Hartford, Connecticut
 Contributors ix

Zachary Stender, MS, MD Mandeep S. Virk, MBBS

Contributors
Department of Orthopaedic Surgery Resident
University of Connecticut Department of Orthopaedic Surgery
Farmington, Connecticut University of Connecticut Health Center
Farmington, Connecticut
Rochelle R. Van Meter, DO
Assistant Professor
Department of Emergency Medicine
University of Connecticut School of Medicine
Farmington, Connecticut
 Preface

Musculoskeletal emergencies including fractures, joint discussion of spinal injuries followed by the upper and
problems, soft tissue injuries, and infections represent lower extremities and pelvis. These anatomically organized
approximately 30% of the problems presenting to U.S. chapters follow a template designed to make the text
emergency departments and urgent care centers. Despite consistent and provide practical guidance for each subject.
the prevalence of musculoskeletal emergencies, curricula The material is presented in short bulleted paragraphs that
in emergency medicine, primary care training, and ortho- simplifies searching for information “just in time” for use
pedic textbooks provide limited education on the detailed in frontline patient care. The extensive pediatric section
differential diagnosis and initial management of such contains a few special chapters containing information
problems in these settings. These patients often require pertinent to children and then follows the anatomic orga-
transfer of care or continuing care. Handoffs are frequently nization of the adult section.
made after the initial diagnosis and management in the Because patients often present with musculoskeletal
emergency department to the follow-up treatment setting complaints referable to one area of the body but without
with an appropriate specialist. Information sharing among a clear diagnosis, each anatomic chapter begins with a
caregivers and to patients needs to be clear and complete. differential diagnosis work-up. Examinations, laboratory
Collaborating care providers and patients deserve clear, tests, and imaging studies needed to determine the under-
concise, and complete information about the diagnosis lying diagnosis and the initial management are discussed.
and treatment plan. We have structured this text and Emergency providers are given guidance about if and
associated electronic media to offer frontline physicians when to call an orthopedic surgeon and the type of con-
essential guidance. We believe this information will also sultation needed. The treatment of each problem is dis-
be of great help to physicians’ assistants, nurse practitio- cussed in detail, including the plan for follow-up and the
ners, paramedics, residents in training, and nurses caring recommended timing.
for these patients. The material has been written to benefit We have asked the contributing authors to include rel-
people with all levels of experience from trainees to expe- evant illustrations and charts to assist the reader in under-
rienced practitioners. standing the concepts and details of diagnosis and
We divided the book into three sections: general, adult, treatment. We are indebted to the Elsevier production
and pediatric. The first chapter covers general principles team who have used color to make the book lively and
of care; this is followed by chapters on radiographic enhanced the ability of the reader to find the information
imaging, infection management, analgesia, regional they need at the right time.
blocks and anesthesia, multiple trauma management,
perioperative work-up of geriatric patients, and manage- Bruce D. Browner, MD, MS, FACS
ment of pregnant women. The adult section begins with Robert P. Fuller, MD, FACEP
 Acknowledgments

The editors would like to thank the following people from  Steven Stave, Design Manager. Steve designed the inte-
Elsevier for their contributions to the conception, con- rior and the cover on this project.
struction, and marketing of this work.  Carla L. Holloway, Marketing Manager. No one would
know about this book without Carla and her team.
 Dolores Meloni, Executive Content Strategist. Dolores  David Dipazo, Video Specialist. David worked to
conceptualized the book with the editors and did all of perfect the edited video sent from the editors. He
the market research and budget development. She then posted the videos on our Expert Consult website
obtained approval for the project and worked with us for all to see.
to get it started.
 Julie Mirra, Content Development Specialist. Julie We would also like to thank our executive assistants for
helped develop the direction of the content and design their support in organizing meetings and communicating
and corresponded with all contributors to get the mate- with authors and the publisher. Dr. Browner and Dr.
rial in the door on time and looking fabulous. Fuller had help from their assistants Sue Ellen Pelletier
 Rachel McMullen, Senior Project Manager. Rachel and Lynda Burns at the University of Connecticut Health
oversaw the copyediting and typesetting of the chap- Center and Dr. Browner’s assistant, Kaye Straw, at Hart-
ters. She also handled review until all pages were ford Hospital.
perfect.
 A Thumbnail Assessment
of Emergency Medicine
in the United States

THE START The race riots in Cincinnati, Ohio, in the late 1960s
provided a crisis. The University of Cincinnati’s Cincinnati
Access to emergency room (ER) care across the United General Hospital ER was crowded with patients who per­
States in the 1950s and 1960s did not keep up with the ceived their care as poor and were dissatisfied with long
needs of the growing postwar population. The numbers waits. Hospital leaders assigned two residents, one in
of practicing physicians had not kept pace with the internal medicine and one in neurosurgery, to come up
growth. Many began to use the ER as their primary source with a plan. They recommended starting a residency in
of medical care. Understaffed, underfunded, and under­ Emergency Medicine (EM). Of course, they were turned
equipped, the ERs were serious problems for most hospi­ down, but they had developed a curriculum and had even
tals. Practicing physicians who staffed community hospitals selected a resident, Bruce Janiak, in 1970. The two origi­
were pressured by demands for their time. They were nators went on to practice their specialties. The “resi­
on-call to the ER during their nonclinic hours. Hospitals dency” struggled on for a few years and almost disappeared
and their affected physician staff became open to ideas but managed to produce leaders in emergency medicine.
that might ease the situation. Richard Levy, a recent graduate, became its head in 1977
In 1961 an overburdened practicing physician, James D. and developed a strong education and research oriented
Mills in Alexandria, VA, decided to limit his practice to ER department while putting community dissatisfaction to
coverage. He pulled together a few of his colleagues and rest. It remains one of the strongest EM residency pro­
they covered the ER around the clock. James Mills (1920- grams in the United States.
1989), respected General Practitioner and proper gentle­ The news that a Residency in Emergency Medicine had
man, is credited as being the “father of emergency begun at the University of Cincinnati was reported in 1970
medicine.” The success of the “Alexandria Plan” caused in a national news magazine. Five new residencies in
several similar groups to form across the country. Chief Emergency Medicine began, more or less simultaneously
among them was a group led by John G. Wiegenstein in 1971-1972 in these teaching hospitals: Los Angeles
(1930-2004), in Lansing, Michigan. Wiegenstein and seven County General Hospital; Hennepin County General Hos­
others boldly formed a society called the American College pital in Minneapolis; Medical College of Pennsylvania in
of Emergency Physicans (ACEP) in 1968. ACEP is now Philadelphia; Louisville General Hospital; and the Univer­
widely accepted as the most effective sounding board for sity of Chicago. The ERs were now called Emergency
the practice of emergency medicine while strongly encour­ Departments (EDs). Just 3 years later, 32 EM residency
aging scientific progress. The vision of these few men and programs were in operation.
women lives on. They looked forward to residency training
for emergency physicians and the attainment of primary
board status for emergency medicine. WELL-EARNED RESPECT

Emergency physicians were considered itinerant know-

ACADEMIA STUMBLES FORWARD nothings by the elite of some specialties in the 1960s.
Board status was needed for emergency medicine. ACEP
Meanwhile, academic institutions responsible for the big- appointed members to a committee on board establish­
city teaching hospitals assigned responsibility for their ERs ment in 1974. This group worked with the American
to the departments of Surgery and Medicine. Although Board of Medical Specialties (ABMS) to gain acceptance
their residency training programs provided some medical as a primary board. Committee member, Peter Rosen, EM
manpower, the need for clinical experience in their special­ Director at the University of Chicago and a staunch enemy
ties did not justify staffing the ER solely with their resi­ of indecisiveness, famously answered endless wavering
dents. The ER was as serious a problem in the “city from the specialties with blunt invective. Nevertheless,
hospitals” as it was in community hospitals. The obvious progress was painfully slow. The first step was to develop
solution was to create a residency program for emergency and administer an oral and written examination designed
medicine. This was not an option because it would have to certify that an emergency physician was capable of
encroached on the privileges and scarce resources pro­ making good decisions in any emergency situation. This
vided to the existing specialties. A crisis was needed to test was to be the American Board of Emergency Medicine
make a change. (ABEM) examination. It was successfully administered in
 A Thumbnail Assessment of Emergency Medicine in the United States xiii

1980 and those who passed it became board certified by the forefront. These processes are well underway in many

A Thumbnail Assessment
an EM “Conjoint Board.” areas. Many primary care clinics consider themselves
Preparing for such an examination was a daunting chal­ “medical homes” where primary care physicians work
lenge for both test takers and those trying to condense with a skilled ancillary staff to coordinate care of patients
the large quantities of useful information into the essen­ with multiple health issues. Ideally, many community
tials the emergency physician needed to safely rescue and resources can be made available to care coordinators to
manage all emergency cases. In 1979 ACEP published help patients weather bad times and thus avoid hospital­
Emergency Medicine, a Comprehensive Study Guide, the ization and excessive use of the Emergency Department
brainchild of Judith E. Tintinalli, EM Residency Director at and in-patient services.
Wayne State/Detroit Receiving. Ronald Krome, Director of Emergency Physician Robert Fuller and Orthopaedic
EM at Wayne State/Detroit Receiving, and myself were Surgeon Bruce Browner have the opportunity to address
co-editors. The three of us enlisted the expert opinions of some of these complex issues in their text Musculoskeletal
many specialists to assure that the most current and most Emergencies. Emergency physicians and orthopedists
useful information was being provided. We had no dif­ share many frustrations (patient obesity, alcoholism,
ficulty obtaining their input. Many excellent chapters were homelessness, and so on). Once again, EM physicians and
submitted. We received much unsolicited positive feed­ their colleagues in all of the specialties should formulate
back from test takers. What seemed to be a crushing and address the essentials of what they need to know to
weight was now liftable. They found themselves confident lead patients into a healthier life. Asking their primary care
in their fund of knowledge across a wide scope and their colleagues and clinics for information about how to assist
ability to make use of it. in this effort is the obvious starting point.
With the Fellow of the College of Emergency Physicians In Minnesota, a rural Emergency Medical Services (EMS)
(FACEP) letters after his or her name, the emergency physi­ provider is attempting to serve as a medical clinic and
cian felt pride in having met the test of competence Emergency Department extender, providing some basic
administered by his and her peers. contact and care to patients unable to travel. Primary care
providers are the traditional leaders in this field, but every
specialty can contribute, and must contribute if the overall
NOW WHAT health of our population is to improve. I look forward to
reading the text. I want to learn more about the possibili­
Emergency medicine, and all of medicine, is going through ties resulting from the collaborative approach between the
of period of needed change. There may be less compart­ specialties.
mentalization of practice. Acute and chronic care may be
less distinct as advances in technology improve communi­ Ernie Ruiz, MD
cations and an emphasis on long-term health comes to
 Contents

PART I SECTION TWOâ•… Lower Extremityâ•…â•… 185

General Principlesâ•…â•… 1
Chapter 13╇ Hip and Thigh 186
Chapter 1 General Principles of Initial Care 2 Fernando Checo, Mark Shekhman,
Michael A. Miranda and Randy L. Olson Alex Goldstein, and Andrew S. Erwteman

Chapter 2 Radiographic Imaging 10 Chapter 14╇ DistalFemur, Knee, and

Alisa Kanfi, Douglas Montgomery, Susan O’Brien, Patella 202
Mary Norton, and Marinella M. Russell Thomas M. DeBerardino, Michael N. Nakashian,
Rochelle R. Van Meter, and Laura Scordino
Chapter 3 Infections Involving the
Musculoskeletal System 23 Chapter 15╇ Ankle 228
Ankita S. Kadakia, Cristina Fe G. Mondragon, Joel V. Ferreira, Michael Aronow,
and Edward L. Pesanti and Shawn Stapp

Chapter 4 Analgesia, Conscious Sedation, Chapter 16╇ Foot 275

Regional Blocks, and Lauren Geaney, Michael Aronow,
and Benjamin H. Evenchik
Anesthesia 37
Robert P. Fuller, Richard Sheppard, SECTION THREEâ•… Central Skeletal Axis
and Richard Gannon
Injuriesâ•…â•… 321
Chapter 5 Multiple Trauma 44 Chapter 17╇ Pelvis 322
Robert T. Brautigam and Vijay Jayaraman
Bruce D. Browner, Michael Pensak,
Chapter 6 Perioperative Assessment 49 Alise Frallicciardi, and Andrew W. Ritting
Nicole Silverstein and Richard Sheppard

Chapter 7 Pregnancy 59
John Greene and Deborah Feldman PART III
Pediatricsâ•…â•… 345
PART II Chapter 18╇ Introduction to Pediatric
Specific Anatomic Regionsâ•…â•… 65 Trauma 346
Mark C. Lee, Silas Marshall, and John C. Brancato
SECTION ONE╅ Spine and Upper Extremity╅╅ 65 Chapter 19╇ Pediatric Pathologic
Chapter 8 Spine 66 Fractures 364
Richard Kamin, Paul A. Anderson, Mark C. Lee, Silas Marshall, and John C. Brancato
Mitchell B. Harris, Jaehon M. Kim,
Chapter 20╇ Pediatric Shoulder and Humeral
Michael A. Finn, Erin Maslowski,
Mark A. Harrast, and Stanley A. Herring Shaft 378
Mark C. Lee, Silas Marshall, and John C. Brancato
Chapter 9 Shoulder 79
Nicholas A. Bontempo, Mandeep S. Virk, Chapter 21╇ Pediatric Elbow 392
Sarah Axler, and Augustus D. Mazzocca Mark C. Lee, Silas Marshall, and John C. Brancato

Chapter 10╇ Elbow and Distal Humerus 100 Chapter 22╇ Pediatric
Forearm and Distal Radius
Mandeep S. Virk, Nicholas A. Bontempo, and Ulna Fractures 412
Megan Cummings, and Augustus D. Mazzocca Mark C. Lee, Silas Marshall, and John C. Brancato

Chapter 11╇ Wrist and Forearm 123 Chapter 23╇ Pediatric Hand Injuries 426
Craig M. Rodner, Adam Fleit, and John Grady Mark C. Lee, Silas Marshall, and John C. Brancato

Chapter 12╇ Hand and Digits 148 Chapter 24╇ Pediatric Cervical Spine
Zachary Stender, Isaac Mussomeli, Jeremy Fried, Fractures 437
Anat Cohen, and Craig M. Rodner Mark C. Lee, Silas Marshall, and John C. Brancato
 Contents xv

Chapter 25╇ Pediatric Thoracolumbar Spine Chapter 30╇ Pediatric

Tibia and Fibular Shaft and

Contents
Fractures 449 Ankle Fractures 492
Mark C. Lee, Silas Marshall, and John C. Brancato Mark C. Lee, Silas Marshall, and John C. Brancato

Chapter 26╇ Pediatric

Fractures of the Pelvis Chapter 31╇ Pediatric Foot 502
and Acetabulum 456 Mark C. Lee, Silas Marshall, and John C. Brancato
Mark C. Lee, Silas Marshall, and John C. Brancato
Appendix╇ Administrativeand Regulatory Issues
Chapter 27╇ Pediatric
Fractures and Dislocations Relating to Emergency Department
of the Hip 463 Management of Musculoskeletal
Mark C. Lee, Silas Marshall, and John C. Brancato Emergencies (web only)
Robert P. Fuller and Bruce D. Browner
Chapter 28╇ Pediatric Femur 471
Mark C. Lee, Silas Marshall, and John C. Brancato

Chapter 29╇ Fractures of the Pediatric

Knee 478
Mark C. Lee, Silas Marshall, and John C. Brancato
 Video Contents

These brief videos will review the common presenta- Wrist Fracture
tions, exam findings, radiographic findings, tech- See Chapter 11: Wrist and Forearm
niques for reduction, post-reduction x-ray, exam,
and care. Hip Dislocation
See Chapter 13: Hip and Thigh
Shoulder Dislocation
See Chapter 9: Shoulder Foot Dislocation
See Chapter 16: Foot
Elbow Dislocation
See Chapter 10: Elbow and Distal Humerus