Bones and joints Archivi - A life at risk

Diagnosis of scaphoid fractures. Are plain radiographs reliable?

It's a busy wednesday morning in ED. A 18 yo guy presents with the right hand upraised and dressed. In the other hand he has a bundle of X ray. “About ten days ago, it was a Saturday night, I was with my new girl-friend. Hitting a punch bag as hard as…

ByCiro Paolillo6 August 20140Comments

Bones and joints

Is my hand broken?

A 24 y/o guy presents in ED with the left hand upraised. “I fell off my bike yesterday – he says – I remember a serious impact with an outstreched palm.” There aren’t wounds, he feels pain on the radial side of left wrist, there is an anatomical snuffbox tenderness. The clamp sign is…

ByCiro Paolillo16 June 20140Comments

Bones and joints

Ottawa ankle rules. Does it really work?

A 16 yo guy is brought in ED by his mother after a scholar accident. While he was running, he crashed. My son has a sore ankle! Is it broken? Asks the mother seriously worried. The ankle his slightly tumefied, there isn’t bone tenderness at the posterior edge or tips of either malleolus,…

ByCiro Paolillo11 April 20140Comments

Bones and joints

Does every shoulder pain means magnetic risonance?

A 35 y/o male come to the ED because of pain in his right shoulder, he refers the pain started some month ago during a tennis match, the pain continued but it wasn't so high so he kept playing in the last months, now it is worse. "My tennis mate told me I should perform…

ByIlenia Spallino9 February 20140Comments

Bones and joints

Low probability of mandibular fracture? C’mon grit your teeth!

It’s a Saturday busy night, in ED when a 31 yo male comes referring pain in the chin and next to the right ear after a trauma. He was out celebrating his birthday, slipped and fell on to his chin. Vital signs are normal, there aren’t wounds, he denies malocclusion, the palpation of the…

ByCiro Paolillo15 September 20130Comments

Bones and joints

Sciatica: only pain control, or imaging? Point your big toe to your nose!!!

A 50 y/o friend of yours called for you. He refers low back pain radiating to his left leg from approximately 2 weeks. “help me doc - he says - I have a sciatica, a dog is biting my buttock, can you favor me with an urgent RMN?”. He is very suffering. During the straight…

ByCiro Paolillo11 July 20130Comments

Bones and joints

Is it broken?

A nthony, a 15 y/o student, slipped and fell while playng soccer. The next morning he refers continue pain on the right elbow. “Is it broken?” ask Anthony and his father at the triage desktop? There is pain and edema near the elbow, no radial pulse deficit, he can fully extend and flex the articulation,…

ByCiro Paolillo7 January 20130Comments

Bones and joints

Is cervical spine X-ray necessary if there is a distracting injury?

A 40 yo lady arrives in ED by ambulance with neck and spinal immobilization because she fell down a staircare. The patient’s vital signs are within normal physiological parameters, she is alert, no deficit, remembers all, denies head contusion and neck pain. She complains for a sharp shoulder pain (NRS 10/10), it seems broken. If…

ByCiro Paolillo7 September 20120Comments

Bones and joints Ultrasound

Septic Arthritis and Arthrocentesis

A 33 y/o male comes to the ED for fever, knee swelling and pain. He has a history of joint surgery because of trauma, and prothesis, dating 4 years before. He is HIV positive He presents feverish (38°C), the left knee is swollen and hot. WBC 34.000/μL, CRP 109 mg/L, PCT 0,05 ng/mL. As we…

ByIlenia Spallino26 January 20120Comments

The Emergency Physician