PEM: Orthopedic injuries and NAT- Dr. Warnick

1. 4 types of child abuse: physical, sexual, emotional, neglect
2. Consider developmental milestones: start to roll at 4 months, crawl at 9 months, taking steps at 12 months
3. TEN4FACES: bruises on torso, ears, neck, angle of jaw, cheeks, eyelids, subconj hemorrhage, frenulum tear; bruises on 4 months or younger; patterned bruising
4. Workup: trauma labs, skeletal survey (under age of 2), CT Head
   • UA > 50 RBC –> CT abd
   • ALT 3x upper limit –> CT abd
   • if low hgb –> look at context
5. Bucket handle fracture/corner fracture = concern for abuse
6. Posterior rib fractures
7. Spiral fracture vs toddler’s fracture
8. Social work, Law Enforcement, CPS report, Transfer to pediatric center

Hand injuries- Dr. Shaw

1. Perfusion: pulses, cap refill, most distal part of hand
2. Sensation: ulnar, median, radial, palmar/volar vs dorsal
3. Motor: “rock, paper, scissors, ok”; FDS vs FDP
4. Phalanx dislocation: frequently have ligamentous disruption, reduction with traction, splint with alumafoam to MCP
5. Nail avulsion: inspect for underlying laceration, repair as needed, suture/dermabond nail back in place
6. Fingertip avulsion injury: finger tourniquets
7. Subungal hematoma: assox with tuft fracture, trephination, abx if open fracture
8. Boxer’s fracture/metacarpal fracture with fight bite: closed reduction with 20-20-40 rule, hematoma block, ulnar/radial gutter splint
9. Scaphoid fracture: assess snuffbox, prone to malunion, thumb spica, follow up outpatient
10. Lunate dislocation: require emergent hand eval
11. Paronychia: I&D, abx if inflammation or abscess
12. Herpetic whitlow: topical acyclovir
13. Sporotrichosis: itraconazole 4-6 months
14. Felon: I&D lateral margin, bactrim
15. Flexor tenosynovitis: kanavel signs- sausage digit, pain with percussion of flexor sheath, held in passive flexion, pain with passive extension; hand consult, IV abx, OR
16. Water bath for ultrasound