ED Rounds – June 2019
Dr. George Xidos
- 10-20% of ED visits are for musculoskeletal injuries
- Unfortunately, most common cause of litigation in Canada
- Pitfalls include missed injuries, failure to recognise
- significance of injuries, inadequate initial management, and
- failure to refer to appropriate specialists in a timely manner
Fundamentals:
● Complete hx : mechanism of injury, age, risk factors
● Accurate physical (e.g. there is more to the wrist exam than checking the “snuffbox” and more to the ankle exam than included in the Ottawa rules)
● X ray studies:
○ 20% of MSk litigation involves failure to order X rays in the first place
○ Ensure adequate quality of films (e.g. proper lateral views of hands, wrists and elbows) and order additional views if required
○ Be acutely aware of common locations for occult fractures: scaphoid, radial head, hip, talar dome, tibial plateau etc.
○ Most commonly missed fracture is the second fracture.
