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Ortho Dx: Small Toe Pain in an Adolescent

Fracture of a phalanx of the foot is a common injury seen in urgent care and the emergency department. These fractures generally occur from a crush injury or stubbing the toe. Phalangeal fractures of the foot rarely require surgery. Surgical indications include unstable rotational deformities, irreducible fracture dislocations, and severely contaminated open fractures. Rotational deformity…

Ortho Dx: Hip Pain Following Fixation of a Fracture

The patient’s radiographs show mechanical failure of the intramedullary nail at the junction of the compression screw and nail. Intramedullary nails are the most common devices used for fixation of peritrochanteric fractures. Once internal fixation is performed, bone healing and weight-bearing restrictions protect the implant from stress that could cause mechanical failure. A fracture that…

Ortho Dx: Forearm Pain Following a Fall

Ulnar fractures most commonly result from injury to the forearm.  Isolated ulnar diaphyseal fractures are known as “night stick” fractures as the injury may occur when the patient blocks overhead contact from a blunt object. Isolated ulnar diaphyseal fractures are notoriously slow healers and have a high rate of nonunion (up to 25% with closed…

Ortho Dx: Chronic Ankle Pain Following Surgery

Painful hardware of the foot and ankle is common following ORIF. The bones of the foot and ankle have little subcutaneous tissue and skin coverage that often causes sensitivity over the underlying hardware. Patients often complain of tenderness as well as heightened pain during activities. Screw displacement with tenting of the skin that is visible…

Ortho Dx: A Painful, Swollen Thumb Following a Football Injury

Most (80%) fractures of the first metacarpal occur at the base and are described as either intra-articular or extra-articular.1 Intra-articular fractures usually occur as a result of an axial force to a flexed thumb. These fractures are divided into 3 types:  Bennett, Rolando, and severely comminuted. In Bennett fractures, the displaced fragment is found at…

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