The Orthopaedic Literature – honestly there is some!

25 Nov

Bond MC, Lemkin DL, Brady W. The orthopedic literature 2009. Am J Emerg Med 2011 Oct.;29(8):943–953. PMID 20934830

I wasn’t sure if this was a spoof when I first read the title but it does indeed appear that there is some evidence for what the bone docs do.

Note it’s written by Michael Bond who’s an EP who does a lot of the ortho stuff on the UMEM educational pearls. 

It’s definitely worth a read, here’s a few things I picked up:

  •  flexing the arm to 90 degrees and then hyperpronating is probably better than pronation-supination method for pulled elbow
  • ultrasound is great for nerve blocks (which hopefully we all knew)
  • after a shoulder dislocation, immobilising the arm in external rotation is probably better than in a sling. If you knew your anatomy then you’d already have guessed that as the closed pack position of the gleno-humeral joint is external rotation
  • while the paper talks about the “accuracy” of certain shoulder examination techniques for sub-acromial impingement, it would seem better to talk about their “inaccuracy” with most kappas at 0.4 and the best AUC at 0.7. This was compared with findings at surgery
  • CT with 5mm slices is probably plenty (when compared to 2mm slices); you miss a few unimportant breaks but unlike plain films you don’t miss the big ones
  • major criteria for fat embolism syndrome include:
    • petechial rash (especially on chest)
    • respiratory insufficiency
    • cerebral involvement
  • apparently the rate of non-union for clavicular fractures is 19-33% (though I somehow doubt that) leading to some recommendations that lateral 1/3 fractures with more than a shaft’s width of separation should get fixed

The paper is well worth a read. Worth noting that an article written about 2009 literature takes 2 years to get published.

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