Orthopedics

And the Best Shoulder Reduction Award Goes to…

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This meta-analysis found Boss-Holzach-Matter/Davos and FARES had the most favorable value for success rates, while both FARES and modified external rotation were more favorable in reduction times. FARES also had the most favorable score for pain during reduction. 

Source
A Systematic Review With Pairwise and Network Meta-analysis of Closed Reduction Methods for Anterior Shoulder Dislocation. Annals of emergency medicine vol. 81,4 (2023): 453-465. doi:10.1016/j.annemergmed.2022.10.020 

Fever, Leg Pain, Pediatrics – Blood Culture or Not?

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Bacteremia is common in pediatric patients who present to the ED with fever and acute lower extremity pain. Obtain a blood cultures in these patients, as it is likely to assist in diagnosis or change management, particularly if they also have a higher fever, focal bony tenderness, or an elevated CRP. 

Source
Bacteremia in Children With Fever and Acute Lower Extremity Pain. Pediatrics. 2023 Apr 4;e2022059504. doi: 10.1542/peds.2022-059504. Online ahead of print.

Does Intra-Articular Lidocaine Work for Shoulder Reduction?

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Intra-articular lidocaine (IAL) is a safe alternative for the reduction of anterior shoulder dislocations and may have similar efficacy to intravenous (IV) sedation, with fewer adverse events and shorter ED length of stay.

Source
Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. CJEM. 2022 Dec;24(8):809-819. doi: 10.1007/s43678-022-00368-z. Epub 2022 Oct 1.

Does Prepatellar Bursitis Need Aspiration?

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Empiric antibiotic therapy – without aspiration – is a reasonable approach for the management of suspected prepatellar septic bursitis in non-toxic patients with close outpatient follow up.

Source
Efficacy of empiric antibiotic therapy without aspiration for septic prepatellar bursitis in emergency department patients. Acad Emerg Med. 2022 Aug;29(8):1027-1032. doi: 10.1111/acem.14499. Epub 2022 Apr 25.

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