Fracture Management for Primary Care E-Book , livre ebook

Fracture Management for Primary Care
Third Edition

M. Patrice Eiff, MD
Professor, Department of Family Medicine, Oregon Health and Science University, Portland, Oregon

Robert Hatch, MD, MPH
Professor, Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
Saunders
Front Matter
THIRD EDITION

Fracture Management for Primary Care
M. Patrice Eiff, MD
Professor
Department of Family Medicine
Oregon Health and Science University
Portland, Oregon
Robert Hatch, MD, MPH
Professor
Department of Community Health and Family Medicine
University of Florida
Gainesville, Florida
Mariam K. Higgins
Medical Illustrator
Portland, Oregon
Copyright

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Fracture Management for Primary Care ISBN: 9781437704280
Copyright © 2012, 2003, 1998 By Saunders, an Imprint Of Elsevier Inc.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).


Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Eiff, M. Patrice.
 Fracture management for primary care / M. Patrice Eiff, Robert Hatch.—3rd ed.
p. ; cm.
 Includes bibliographical references and index.
 ISBN 978-1-4377-0428-0 (pbk.)
 1. Fractures. 2. Primary care (Medicine) I. Hatch, Robert, 1957- II. Title.
 [DNLM: 1. Fractures, Bone—diagnosis. 2. Fractures, Bone—therapy. 3. Primary Health Care—methods. WE 180]
 RD101.E34 2012
 617.1’5—dc23
2011017590
Senior Acquisitions Editor: Kate Dimock
Senior Developmental Editor: Janice Gaillard
Publishing Services Manager: Patricia Tannian
Team Manager: Hemamalini Rajendrababu
Senior Project Manager: Sharon Corell
Project Manager: Deepthi Unni
Design Direction: Ellen Zanolle
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contributors

M. Patrice Eiff, MD, Professor Department of Family Medicine Oregon Health and Science University Portland, Oregon

Robert L. Hatch, MD, MPH, Professor Department of Community Health and Family Medicine University of Florida Gainesville, Florida

John Malaty, MD, Assistant Professor Department of Community Health and Family Medicine Shands Hospital at University of Florida Gainesville, Florida

Ryan C. Petering, MD, Clinical Instructor Department of Family Medicine Oregon Health and Science University Portland, Oregon

Michael J. Petrizzi, MD, Clinical Professor Department of Family Medicine Virginia Commonwealth University School of Medicine Richmond, Virginia

Adam Prawer, MD, Family Medicine Resident Department of Family Medicine Bayfront Medical Center St. Petersburg, Florida

Michael Seth Smith, MD, PharmD, University of Florida Department of Community Health and Family Medicine Gainesville, Florida

Charles W. Webb, DO, FAAFP, Associate Professor Director, Sports Medicine Department of Family Medicine Associate Professor Department of Family Medicine and Orthopedics Oregon Health and Science University Portland, Oregon
Preface
From the earliest conception of this book through the publication of this third edition, it has always been our intent to produce a practical user-friendly book that helps clinicians manage their patients who have fractures. We have accomplished this through a systematic approach to each fracture that enables you to find the information you need quickly, including what to look for, what to do in the acute setting, how to manage the fracture long term, and when to refer. The many high-quality radiographs and illustrations help clinicians properly identify those fractures that can be managed by primary care providers and those that need to be referred. The basic systematic format of the text has been retained, but information from the second edition has been significantly revised to include current evidence and references. We have expanded the discussion in the imaging sections for each fracture to include evidence regarding preferred modalities for identifying fractures. Aspects of the emergency care of fractures, including guidelines for emergent referral and greater detail regarding methods for closed reductions for fractures and dislocations, are featured in this edition. New radiographs and illustrations have been added to give you optimal examples of the fractures you will encounter.
This edition builds on the success of the second edition and gives you an even better reference for your practice. One of the most notable changes is the addition of an entire section devoted to step-by-step instructions on applying a variety of splints and casts. Another update in this edition is the inclusion of patient education handouts that can be downloaded from the online version of the book. These handouts will give your patients information about the healing process and the kinds of rehabilitation exercises they can do to return to full activity after an injury. The online book also includes videos covering techniques for splinting and reducing dislocations.
We would like to thank the many individuals who helped us in the preparation of this edition. We thank our contributing authors for their assistance with individual chapters and the appendix: Ryan Petering, MD (Finger Fractures and Carpal Fractures), Charles Webb, MD (Metacarpal Fractures), John Malaty, MD (Facial and Skull Fractures), Adam Prawer, MD (Radius and Ulna Fractures), Michael Seth Smith, MD (Metatarsal Fractures), and Michael Petrizzi, MD, and Timothy Sanford, MD (Appendix). We thank Walter Calmbach, MD, for his contribution to the first two editions of the book. We also thank Janice Gaillard, senior developmental editor, at Elsevier for her guidance and advice. And finally, we are grateful to the many practicing clinicians who have encouraged us to take this next step in pursuit of our vision to give you the most accurate and practical working guide to fracture management.

M. Patrice Eiff

Robert L. Hatch
Introduction

M. Patrice Eiff, MD

Fracture Management: A Personal View



I’ve always enjoyed teaching sports medicine and fracture management, but I never aspired to become an orthopedic teaching case. That was all to change on the Mambo Run in January 1988.
While I was lying in the snow awaiting transport, my mind quickly began running through a differential diagnosis. My first thought was a femur or tibia fracture. A few torn ligaments were certainly a possibility. After the Ski Patrol member said, “Something doesn’t feel quite right,” I revised my differential to put patellar dislocation at the top of the list. Of course, that must be it. I wanted that to be it.
In the emergency department of the local hospital, I got the first glimpse of my knee. Admittedly it didn’t look right, but I was unwilling to broaden my differential. The physician on duty pulled the sheet back and said something like, “Oooh! Give her some morphine and call the orthopedic surgeon.” My concern was mounting. As I was wheeled back from the X-ray department, I overheard my surgeon and skiing companion remark to the ED physician, “I don’t look at bone films too often, but even I can tell that these don’t look quite right.”
My X rays that “don’t look quite right&