POCUS for distal radius fracture reduction confirmation. Avoid unnecessary check x-ray trips

$Radius Fracture on POCUS Great example of the use of POCUS to diagnose a fracture of a$

Radius Fracture on POCUS Great example of the use of POCUS to diagnose a fracture of a long bone - look for cortical disruption and also to help guide reduction. Could also do X-ray after reduction to confirm proper alignment in both planes. gerPOCUS DFTT @GERpocus #Radius #Fracture #POCUS #clinical #bone #msk #orthopedics

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Galeazzi Fracture Fracture of distal radial shaft with distal radial-ulnar joint disruption. Remember “MUGR” to recall where the fracture is located. Here’s a quick summary. • Fracture of distal radial shaft with distal radial-ulnar joint (DRUJ) disruption, peak age 9-13 • Radius fracture will be obvious; signs of DRUJ disruption on x-ray include ulnar styloid fracture, widened DRUJ (usually 1-2 mm), 25 mm of radial shortening • Mechanism: Fall onto outstretched hand • Exam: swollen forearm and wrist, limited ROM especially in supination/pronation and at wrist • Possible associated injuries: Rare • ED Management: Pain control • Splint: Posterior long arm with supination • Ortho consult: Yes • Disposition • Children: closed reduction of radius and DRUJ, usually do not require operative intervention • Adults: closed reduction of radius and DRUJ, always followed by ORIF of radius and stabilization of DRUJ MH/CCF/CWRU EM Res @MetroHealth_EM #Galeazzi #Fracture #Forearm #Radius #Radial #Distal #Radiology #XRay #Diagnosis #Management #Orthopedics #MSK

$Hematoma block on POCUS for a distal radius fracture. Procedures: better with POCUS. Some applications that aren't taught$

Hematoma block on POCUS for a distal radius fracture. Procedures: better with POCUS. Some applications that aren't taught in an intro course of FAST, basic echo, etc allow for the sort of everyday ultrasound use that's most useful and rewarding - good for both clinicians and patients. Dr. David Mackenzie @mackendc #Hematoma #block #POCUS #radius #fracture #clinical #ultrasound #anesthesia

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$Distal Radius Fracture Distal radius fracture is the most common orthopedic injury. Here's a quick summary. •$

Distal Radius Fracture Distal radius fracture is the most common orthopedic injury. Here's a quick summary. • Fracture at the metaphysis or articulation of distal radius • Most common orthopedic injury • Eponyms: • Colles (90% "dinner fork") = dorsally displaced. extra-articular • Smith ("reverse Colles") = volar displaced. extra-articular • Barton = intra-articular dorsal or volar (more common) rim fracture • Chauffer = radial styloid fracture • Mechanism: Fall onto outstretched hand • Exam: variable gross wrist deformity with decreased ROM • Possible associated injuries: DRUJ disruption, radial styloid fracture, median nerve injury, acute carpal tunnel syndrome, soft tissue injuries (TFCC injury, scapholunate and/or lunotriquetral ligament injury) • ED Management: Hematoma block +/- procedural sedation and reduction using finger traps • Splint: Sugar tong • Ortho consult: No if Colles or Chauffer unless unable to reduce; Yes if Smith or Barton • Disposition: DC home if Colles or Chauffer with orthopedic follow-up within I week; Smith or Barton, pending orthopedic recommendations MH/CCF/CWRU EM Res @MetroHealth_EM #Radius #Fracture #Forearm #Radial #Colles #Distal #Radiology #XRay #Diagnosis #Management #Orthopedics #MSK

Talus Fracture on POCUS Athlete with hard landing on one foot, pain and tenderness over dorsum of foot distal to tibiotalar joint. POCUS showed talus neck fracture with displaced fragment. - drshukla14 @DrShukla14 #Talus #Fracture #POCUS #clinical #ultrasound #MSK #ankle

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Finger Fracture on POCUS 50yo female presents with 5th finger pain after her dog pulled on his leash while taking a walk. Which of the following best represents your next step? Resolution: Splint fracture. For those who requested x-ray: there was high pre-test prob for dislocation. If pocus confirmed, provider could reduce & perform single post-reduction x-ray. Instead, shared pocus finding with pt & awaited x-ray. 1 hr later, fracture confirmed. #Finger #Fracture #POCUS #clinical #ultrasound #MSK

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Rib Fracture on POCUS There is an interruption in the continuity of this bone (rib), indicated by the arrow, representing a fracture. Ultrasound is superior to X-ray in diagnosing rib fractures. Dr. Meghan Herbst @EUSmkh #Rib #Fracture #POCUS #clinical #ultrasound #msk

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$RADIAL HEAD FRACTURE Radial head fractures are the most common elbow fracture in adults and are$

RADIAL HEAD FRACTURE Radial head fractures are the most common elbow fracture in adults and are also the most commonly missed elbow fracture! Here’s a quick summary. • Most common elbow fracture in adults, also the most commonly missed elbow fracture • When looking at an elbow x-ray review alignment (anterior & radiocapitellar lines), fat pads (anterior & posterior) and bone cortex • If a fracture cannot be identified but anterior sail sign or posterior fat pad is seen, treat as non-displaced radial head fracture! • Mechanism: Fall onto outstretched hand • Exam: Tenderness to lateral elbow, limited ROM especially in supination/pronation • Possible associated injuries: Ligamentous injury (LCL > MCL), coronoid or olecranon fracture, distal radioulnar joint injury, interosseous membrane injury, elbow dislocation, scaphoid fracture • ED Management: Pain control • Splint: Sling • Ortho consult: No, if Type l; Yes, if Types II-IV • Disposition: Type I, DC with ortho follow-up within 1week; Types II-IV, pending orthopedic recommendations MH/CCF/CWRU EM Res @MetroHealth_EM #RadialHead #Radius #Fracture #Elbow #Radiology #XRay #Diagnosis #Management #Orthopedics #MSK

$Sternal Fracture on Ultrasound Sternal fractures are not seen on x-ray. Here you can see the step-off$

Sternal Fracture on Ultrasound Sternal fractures are not seen on x-ray. Here you can see the step-off and hematoma. Just don't mistake the manubrium for a step-off! Dr. J. Christian Fox @jchristianfox #sternal #fracture #trauma #pocus #clinical #ultrasound #sternum #stepoff

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$Triquetral Fracture The triquetrum is the second most commonly fractured carpal bone. Look for the "pooping duck$

Triquetral Fracture The triquetrum is the second most commonly fractured carpal bone. Look for the "pooping duck sign" on lateral x-ray! Here's a quick summary: • Second most common carpal bone fracture • Complications are rare but can include functional deficit and arthritis if missed • Look for the "pooping duck sign" on lateral x-ray • Mechanism: Fall onto outstretched hand or direct blow to dorsum of the hand • Exam: Swelling and tenderness just distal to distal ulna, pain with wrist flexion and extension • Possible associated injuries: Perilunate dislocation, distal radius or ulna fractures • ED Management: Pain control, immobilize • Splint: Volar • Ortho consult: No • Disposition: Discharge with orthopedic follow-up within 1 week MH/CCF/CWRU EM Res @MetroHealth_EM #Triquetral #Triquetrum #Fracture #Wrist #Carpal #Radiology #XRay #Diagnosis #Management #Orthopedics #Sports #MSK

Anterior Shoulder Dislocation and Reduction on POCUS The transducer is placed posteriorly over the shoulder, revealing anterior displacement of the humeral head (anterior dislocation) Reduce (ideally after an ultrasound-guided interscalene or shoulder (intra-articular) block Dr. Meghan Herbst @EUSmkh #Anterior #Shoulder #Dislocation #Reduction #POCUS #clinical #anatomy #msk #ultrasound #labeled

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Hippocratic Shoulder Reduction Shoulder reduction is the process of returning the shoulder to its normal position following a shoulder dislocation. Normally, closed reduction, in which the relationship of bone and joint is manipulated externally without surgical intervention, is used. A variety of techniques exist, but some are preferred due to fewer complications or easier execution. In cases where closed reduction is not successful, open (surgical) reduction may be needed. X-rays are often used to confirm success and absence of associated fractures. The arm should be kept in a sling or immobilizer for several days, prior to supervised recovery of motion and strength. Note: The Hippocratic method for shoulder reduction, though “classic,” is not a commonly used technique. Increases risk of axillary nerve injury. Many other safer and more effective techniques available, including reduction under sedation. #Hippocratic #Shoulder #Reduction #MSK #PhysicalExam #Procedure #Orthopedics #clinical #video #dislocation

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Anterior Shoulder Dislocation and Reduction on POCUS Shoulder scan, convex transducer, top of screen is posterior for both clips. A) shows an anteriorly dislocated humerus (displaced from the scapula and glenoid towards the bottom of the screen (more anterior). B) shows the joint intact after successful reduction. Dr. Meghan Herbst @EUSmkh #Anterior #Shoulder #Dislocation #Reduction #POCUS #clinical #ultrasound #msk #radiology #labeled

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$Rib fractures on POCUS 1. look for a discontinuity at the site of pain and tenderness$

Rib fractures on POCUS 1. look for a discontinuity at the site of pain and tenderness 2. US beats CXR on time, cost, accuracy, and radiation. Most CXR are wasted on rib fx 3. Satisfies pt desire for imaging and validation beyond a clinical diagnosis; the biggest reason I do it. If looking for rib fx w POCUS, orient in line on long axis with the rib course based on chest location. Then rotate to confirm in the short axis plane. Be wary of the bone - cartilage junction...easy to interpret this as a step off / fracture. - Dr. David Mackenzie @mackendc Patient can guide you to the site of tenderness. Look for disruption of bony cortex and or associated overlying hematoma. Could be time consuming, and won't completely replace x-ray! #Rib #fracture #POCUS #clinical #ultrasound #trauma

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Nonossifying Fibroma with Pathologic Fracture - MSK Radiology Imaging Findings: • Cortically based, geographic, lucent lesion with a sclerotic peripheral margin measured > 3cm. • MRI demonstrates the cortically based lesion with T1- and T2-heterogenous signal with regions of hypointense signal representing fibrous/hemosiderin portions. The arrows delineate a nondisplaced linear fracture emanating from the lesion into the femoral metadiaphysis with surrounding marrow edema. Case description: • Nonossifying Fibroma and Fibrous Cortical Defects are histologically similar and sometimes differentiated based on size (NOF > 3cm). Both coined "Fibroxanthoma". • Do Not Touch lesions with no follow-up or biopsy necessary in almost all cases. Diagnose with X-RAY; usually resolve by age 20-25. • This case shows potential of pathologic fracture in athletes. • Multiple NOF's in NF-1 or Jaffe-Campanacci syndrome. Differential diagnosis for similar lesion: • Simple bone cyst: Central, "cyst-like" lesion on MRI without hypointense fibrous tissue. • Aneurysmal bone cyst: Eccentric expansile lesion, MRI shows fluid-fluid levels. Dr. Donald von Borstel @DrvonBorstel #Nonossifying #Fibroma #NOF #Fracture #clinical #mri #clinical #Radiology #diagnosis #msk

$Prior anterior glenohumeral joint dislocation with Hill-Sachs fracture and Perthes lesion Imaging Findings: • The arrow is$

Prior anterior glenohumeral joint dislocation with Hill-Sachs fracture and Perthes lesion Imaging Findings: • The arrow is displaying hyperintense signal of the anteroinferior glenoid labrum tear. There is also stripping of the glenoid periosteum and uplifting of the anterior labrum from the glenoid (solid arrows) without detachment. This is a Perthes lesion. • These ovals are outlining the impaction fracture of the superolateral humeral head. • Measure the depth of the Hill-Sachs impaction fracture on Coronal (>4mm). - Also measure approximate % of humeral head involved using the linear method (A/B). Case description: • Anterior glenohumeral joint dislocations often present with a combined anteroinferior glenoid pathology and humeral head posterolateral Hill Sachs impaction fracture. • Anterior labroligamentous tear with periosteal stripping → Perthes lesion. - Difficult to see on arthroscopy due to granulation tissue and no labral displacement. • Hill-Sachs impaction fracture in 80% of anterior GH dislocations. Measure the depth (or % of humeral head) of the deformity: >4mm depth is more prone to engagement/recurrence → surgical repair. >25% of humeral head → likely surgical repair Differential diagnosis: • Bankart lesion: Anteroinferior labral tear and inferior glenohumeral ligament detached. No periosteal stripping or displacement and NO osseous component. • Bony Bankart: Osseous defect of the anterior glenoid rim with an associated anteroinferior labroligamentous tear. • ALPSA: Anterior Labrum Periosteal Sleeve Avulsion. Similar injury to the anterior glenoid labrum with anterior glenoid periosteal stripping. However the labrum displaces medially → CHRONIC INSTABILITY • GLAD lesion: Glenoid Labrum Articular Disruption: superficial anteroinferior labral tear with an adjacent focal chondral defect of the glenoid. Dr. Donald von Borstel @DrvonBorstel #HillSachs #fracture #Perthes #lesion #clinical #mri #clinical #Radiology #diagnosis #msk

MTP Gout Effusion on POCUS 50s male with DM/HTN (no hx gout) and great toe pain-MTP joint. Hx of IVDU. No trauma. Just tx as gout? What now? Could try tap without using ultrasound first to confirm jt effusion or to guide aspiration. Not had much luck with that approach over the years. X-rays= DJD, no acute process. POCUS revealed joint effusion in 1st MTP joint. Ankle block with u/s. Switched to hockey stick probe. In-plane aspiration. WBC-48K. Gram stain neg (culture ultimately neg also). MSU crystals=Gout. POCUS for the win. Labeled Schematic: https://twitter.com/RJonesSonoEM/status/1354602657734946817 Dr. Robert Jones @RJonesSonoEM #MTP #Gout #Effusion #Clinical #POCUS #ultrasound #MSK #Toe

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Posterior Knee Dislocation Injury Specifically, POSTERIOR KNEE DISLOCATIONS can have significant associated injury that needs unique approach and workup. SPONTANEOUS REDUCTION: can occur up to 50% prior to ER arrival, and thus suspicion needed with mechanism of injury. POSTERIOR DISLOCATION: ~25% cases. Neurologic deficit can signal vascular injury. ASSOCIATED INJURIES: 1.Popliteal artery injury-->Cannot rule out based on normal distal pulses and Ankle Brachial Index (ABI) > 0.9 Requires definitive vascular imaging or serial exams 2. Neurologic injuries 3. Common peroneal nerve injury (25%) TEST FOR: Sensation in 1st dorsal web space, Dorsiflexion of foot, Toe extension, Tibial nerve injured (less common) 4. Fractures-> Femur and tibia most common. Check hip and ankle joints for associated fracture. Avulsion fractures common 5. Compartment syndrome risk high with vascular compromise. CLINICAL: instability with lachmans, posterior drawers, and special ligament/meniscus testing. Obtain full neurovascular eval w/ doppler. Evaluate compartments and consider compartment syndrome. WORK UP: obtain x-rays, vascular assessments (ABIs: Ankle-Brachial-Index). Consider CT. If suspicious of posterior dislocation or vascular injury---> CT with angiography. Also, think of tibial plateau injury. SEGOND FRACTURE: Avulsion fracture (small) of the lateral surface of the lateral tibial condyle. Usually results from excessive internal rotation and varus stress--->>>> LINK TO ACL TEARS. Consider trauma/vascular/orthopedic consult for these types of injury. Rapid reduction needed for neuro/vasc compromise. the_resuscitationist @the_resuscitationist #Knee #Dislocation #Posterior #Injury #msk #clinical #video #nsfw

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Anatomy of the Knee X-ray - AP projection. ⁣⁣ It’s important to be able to identify the normal structures not only to identify the abnormality but to describe it as well!⁣⁣ A systematic review involves multiple views but I typically use the AP view to look at these.⁣⁣ ⁣⁣1. Tibio-femoral alignment - draw a line from the lateral margin of the femur drawn straight below. If the tibia is observed more than 5mm beyond it, think of a fracture of the tibial plateau.⁣⁣ ⁣⁣2. Plateaus - common site for several types of fractures including Avulsion of the tibial spine or of the plateau (Segond/reverse segond)! ⁣⁣ ⁣⁣3. Calcification - especially around the medial epicondyle called Pellegrini- Steida lesion.⁣ ⁣ ⁣4. Joint Space - Check for asymmetry between medial and lateral compartments and be wary of positioning errors!⁣ ⁣⁣ To asses the patella or to look for effusion/hemarthrosis, I typically use a lateral view as it provides more information!⁣⁣ Dr. Devpriyo Pal @drdevrad #knee #xray #clinical #radiology #anatomy #ap #radiology #msk #orthopedics #labeled

Hand X-Ray Anatomy and Interpretation Checklist 1. Soft tissues - Look carefully at the soft tissue over all the bones for any swelling or foreign body. The swelling should prompt a careful search of the underlying bone or joint.⠀ 2. Bones - All the bones of the hand should be examined carefully and systematically. I start from the phalanges and move inwards into the hand and wrist joint and then I move from lateral to medial. The cortex should be carefully evaluated followed by the trabecular pattern. ⠀ 3. Joints - The area in between the bones are very important. In case of a fracture, articular involvement should carefully be looked for while in non-traumatic indications, joint evaluation is very important to look for signs of arthritis. Normally, 1-2mm joint space is seen.⠀ 4. Alignment - Although this falls under bones and joints, this should be kept in mind because often the deviation from normal alignment is subtle. Incorrect alignment of bones across a joint or even the joints as a whole almost always signifies underlying pathology.⠀ 5. Other areas - Last but not the least, look at everything else in the radiograph - the radius and ulna is also seen proximal to the carpal bones.⠀ 6. Other hand - In case of a non-traumatic indication, always compare both the hands. Both hand views are typically ordered for rheumatological diseases. Dr. Devpriyo Pal @drdevrad #Hand #XRay #Anatomy #Interpretation #Checklist #radiology #labeled