Orthopedics in a nutshell…If it’s bent straighten it.
OK, I know that’s not always true, but during residency, the orthopedic residents came down to evaluate most fractures, especially if they were dislocated, angulated, etc. The ER residents got to watch, and if it was a kid, we did the sedation. So it was good experience.
But now that I’m stuck way up in the mountains, I’ve reduced a bunch of fractures that I never would get a chance to in a large university hosptial. Today’s fracture was an angulated radius/ulna fracture in a little boy who tripped in a shoe store, came in by ambulance. The paramedic put on a fantastic cardboard splint and gave the boy a teddy bear. The great thing about getting to know your paramedic crew is that you can trust what you hear. She said it was deformed with no skin lacerations and splinted in the field. I went ahead and got an xray without removing the splint so that I wouldn’t cause any unnecessary pain. He had a nice fracture, non-displaced, no growth plates, and I knew that I could reduce it easily with a little “sleepy medicine” (for him, not me).
We called in our CRNA who used my favorite agent, propofol, and I took down the splint, pulled a little, pushed a little, felt the bones pop back, and his arm looked pretty straight to me. THe post reduction x-rays were beautiful. I’d be surprised if the orthopedic surgeon needs to do anything other than cast it.