eci limb x-ray interpretation (1) - nsw agency for ... · ottawa ankle rules pain in the malleolar...
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ECIN
SWX-rays of Limbs
C NI - S W
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Emergency Care lnstitut NEW SOUTH WALES
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Describe the injury1. Mechanism2. Neurovascular status3. Open/Closed4. Limb deformity5. Other injuries6. Describe the fracture
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Describe the fracture Side (handedness?) Bones involved Any dislocations Transverse, Oblique, Spiral Joint involvement Displacement Angulation ?pathological
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Upper Limb Common injuries Classic mechanisms are FOOSH and punches Look for other injuries
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Treatment
Analgesia
ReduceImmobilise
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Lower LimbKnee
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Ottawa Rules (knee)Age 55 or over.
Isolated tenderness of the patella (no boney tenderness of the knee other than the patella).
Tenderness at the head of the fibula.
Inability to flex to 90 degrees.
Inability to weight bear both immediately and in the ED (ie, 4 steps – unable to transfer weight twice onto each lower limb regardless of limping).
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Emergency Care lnstitut
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JMO Teaching 2012
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JMO Teaching 2012
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JMO Teaching 2012
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Below the Knee
JMO Teaching 2012
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JMO Teaching 2012
“It Really Hurts”
“It ReallyHurts”
“It ReallyHurts”
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Ottawa Ankle Rules
Pain in the malleolar zone and any one of the following:
Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus.
Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus.
Inability to bear weight for 4 steps both immediately and in the emergency department.
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Salter Harris Classification
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Peroneus terti us tendon
F"eron eus brevis tendon Fl' lan~r fascia
Lateral vi eN
Tuberosity avulsion tfta dure s
IIJ Proximal fltlli metatarsal rtacrures within 1.5 em of the hJ berosj ty
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Emergency Care lnstitut NEW SOUTH WALES
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Bohler’s Angle:25 - 400
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Summary Please view all X-rays and we will discuss in the
workshop Treat the whole patient Analgesia Splint Neurovascular examination, and again Follow up
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With thanks: Dr Dane Chalkley EDSS , POW Hospital NSW