Crossword Puzzles:
Antidotes Used In Toxicology

Orthopedics

This patient is a 28 year old female presents to the ED with the complaint of left shoulder pain after a fall. The following x rays are shown.

Questions:

1. Describe what you see? Fracture of the left acromion. No evidence of shoulder dislocation. Normal left clavicle.

Diagnosis: Fracture of the left acromion

 2. How does this injury typically occur?

• Acromion fractures typically result from a downward blow to the shoulder. Superiorly displaced fractures may occur as the result of a superior dislocation of the shoulder.

3. What would you find on physical exam?

• Tenderness directly over the acromion process is the most common finding.
• Deltoid contraction and arm abduction exacerbate pain.
• Perform a careful neurologic examination to determine the presence of an associated brachial plexus injury.

4. What would be the management for this patient?

• Nondisplaced fractures of the acromion usually can be treated with sling immobilization, ice, and analgesics.
• Displaced fractures and those associated with rotator cuff injuries often require surgical intervention.
• Follow-up care with an orthopedic surgeon is advised in all cases because of the possibility of long-term complications such as bursitis and posttraumatic arthritis.

Jimmy Buffett Trivia: The song "Margaritaville" contains a "lost verse," which is only sung at concerts. According to this verse, what do the old men wear?

• Answer: Tank tops

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