Which fractures need ortho consult in the ED? Which ones can be discharged to see ortho later (referral)?
I'm doing a "deep-dive" of this topic, since I feel that my residency program didn't really prepare us well for ortho fx topics. I thought this was pretty straightforward to learn, as I just started being an attending. However... Anyone out there feel that learning ED dispositions of ortho fractures can sometimes be more difficult than it should be?? I say this because different sources sometimes have different recommendations.
Some examples... (given that fx are not open, and without neurovasc compromise):
DISPLACED OLECRANON:
1) First Aid for EM Boards: consult ortho in ED
2) Tintinalli's: ortho referral
3) Uptodate: consult ortho in ED
DISPLACED PROXIMAL HUMERUS FX:
1) First Aid for EM Boards: ortho referral
2) Tintinalli's: consult ortho in ED
3) Uptodate: ortho referral
DISPLACED SUPRACONDYLAR:
1) First Aid for EM Boards: ortho referral
2) Tintinalli's: consult ortho in ED
3) Uptodate: consult ortho in ED
GALEAZZI FX:
1) First Aid for EM Boards: ortho referral
2) Tintinalli's: consult ortho in ED
3) Uptodate: "likely" consult ortho in ED
I was hoping Orthobullets would clarify, unfortunately many times it only answers which are "Operative" and "Nonoperative" but doesn't usually answer the questions above. I realize that some practice differences may be due to local ED agreements with local orthopods.
Anyone would like to offer suggestions?
I'm doing a "deep-dive" of this topic, since I feel that my residency program didn't really prepare us well for ortho fx topics. I thought this was pretty straightforward to learn, as I just started being an attending. However... Anyone out there feel that learning ED dispositions of ortho fractures can sometimes be more difficult than it should be?? I say this because different sources sometimes have different recommendations.
Some examples... (given that fx are not open, and without neurovasc compromise):
DISPLACED OLECRANON:
1) First Aid for EM Boards: consult ortho in ED
2) Tintinalli's: ortho referral
3) Uptodate: consult ortho in ED
DISPLACED PROXIMAL HUMERUS FX:
1) First Aid for EM Boards: ortho referral
2) Tintinalli's: consult ortho in ED
3) Uptodate: ortho referral
DISPLACED SUPRACONDYLAR:
1) First Aid for EM Boards: ortho referral
2) Tintinalli's: consult ortho in ED
3) Uptodate: consult ortho in ED
GALEAZZI FX:
1) First Aid for EM Boards: ortho referral
2) Tintinalli's: consult ortho in ED
3) Uptodate: "likely" consult ortho in ED
I was hoping Orthobullets would clarify, unfortunately many times it only answers which are "Operative" and "Nonoperative" but doesn't usually answer the questions above. I realize that some practice differences may be due to local ED agreements with local orthopods.
Anyone would like to offer suggestions?