Dec 11 2020
Intra-articular Lidocaine for Shoulder Dislocation
Spoon Feed
Intra-articular lidocaine (IAL) compared to IV sedation for shoulder dislocation reduction had similar reduction of pain, fewer complications, lower cost, and decreased ED length of stay. However, some patients prefer sedation over IAL, and first time success may be higher with sedation.
Oct 29 2020
What Fracture at What Age Means Abuse?
Spoon Feed
Children <3 years with a rib fracture or <18 months with a humerus or femur fracture need further workup for abuse.
Oct 27 2020
Best Tests for Septic Arthritis
Spoon Feed
The best predictors of septic arthritis in the knee were synovial WBC and Gram stain. Synovial lactate and PCR performed poorly, and no features of the history or exam were helpful.
Oct 02 2020
MSK Ultrasound for Shoulder Dislocation
Spoon Feed
This posterior ultrasound (US) approach to identify shoulder dislocation had 100% sensitivity and specificity for shoulder dislocation and was faster than x-ray by 43 minutes. However, the 92% sensitivity (with a lower 95% CI of 60%) for identifying non-Hill-Sachs/Bankart fracture makes me cautious about completely adopting POCUS until larger studies are done.
Jul 22 2020
Scaphoid Fractures – Spoon-Feed Version
Spoon Feed
Scaphoid fractures are the most common carpal bone injury, yet they are still commonly missed. Maintain a high clinical suspicion for scaphoid injury even with negative radiographs.
Jul 08 2020
Do NSAID, COX-2, or Opioid Rxs Increase Non-Union Risk?
Spoon Feed
Selective COX-2 inhibitors appear to increase risk for fracture non-union. Regular NSAIDs do not. Opioids may also increase non-union risk, although this association may have been confounded.
Jun 09 2020
Are We Reducing Too Many Pediatric Radius Fractures?
Spoon Feed
Over one quarter of children under 10 with distal radius fractures may be undergoing sedation and fracture reduction unnecessarily.
Mar 24 2020
Toddler’s Fracture – CAM Walker Boot, Cast, or Nothing?
Spoon Feed
This study was inconclusive, but provides assurance that treating children with confirmed or suspected toddler’s fracture (TF) in a controlled ankle motion (CAM) walker boot is safe and equally effective compared to casting.
Mar 23 2020
Cast or Walking Boot for Achilles Tendon Rupture?
Spoon Feed
A walking boot vs rigid cast resulted in equal outcomes and adverse events, including tendon re-rupture rate at 9 months for patients with Achilles tendon rupture.
Jan 28 2020
Lever Sign – A Better ACL Exam Technique
Spoon Feed
Compared to other clinical tests of anterior cruciate ligament disruption, the lever sign is more accurate and sensitive in an ED setting.