Merriam-Webster defines an emergency as “an unexpected and usually dangerous situation that calls for immediate action.” Most outpatient clinic visits, especially orthopedic outpatient clinic visits, do not fall into this category. Outpatient orthopedic conditions are rarely dangerous and seldom require immediate action, so encountering an orthopedic emergency in an outpatient setting would certainly be “unexpected.” But, it can, and does, happen, and missing an orthopedic emergency can have devastating consequences. This chapter is intended to arm primary care providers with the knowledge they need to identify orthopedic emergencies when they see them and to give them a strategy for dealing with orthopedic emergencies in those rare instances when they might present in an outpatient setting.
Let’s start with two orthopedic emergencies you’ll likely never see outside the emergency room but are common enough to deserve a few lines of explanation in the chapter.
Acute, traumatic toe and (more commonly) finger amputations are injuries you may never see but may well encounter in the form of a panicked phone call from a hysterical patient who hasn’t thought things through enough to just head straight to the nearest emergency room. The instructions for this patient are simple:
Call 911 and request an ambulance for expedient transport to the nearest emergency department. It is not recommended that these patients drive themselves to the emergency room as blood loss and shock may impair reaction time and judgment or even result in a loss of consciousness.
Do not eat or drink anything. If the digit is to be surgically reimplanted, immediate surgery is necessary, and an empty stomach makes general anesthesia much safer.
Wrap the amputated digit in a clean, moist cloth and place it in a plastic bag. Seal the bag and place it in a second bag filled with ice. Cooling the amputated part will prolong its viability and increase the odds that the reimplantation will succeed.
INJURIES THAT RESULT IN AN UNSTABLE SPINE
Any patient with severe neck or back pain after significant trauma may have an unstable spine. Displacement of an unstable spine can result in spinal cord or nerve root injury and permanent neurologic impairment. “Severe pain” and “significant trauma” are subjective criteria, which can make diagnosing an unstable spine difficult. It is prudent to err on the side of caution. If there is any doubt or if the patient is complaining of neurologic symptoms (numbness, tingling, weakness), the patient should be evaluated in the emergency department with either flexion/extension x-rays or a magnetic resonance imaging (MRI) of the spine.
POST-TRAUMATIC COMPARTMENT SYNDROME
Post-traumatic compartment syndrome is a rapidly evolving, potentially devastating complication of blunt injury to an extremity. Crush injuries can result in compartment syndrome as well. In the extremities, muscle groups are contained in thick, dense envelopes of fascia called compartments. ...