Episode 52: Commonly Missed Uncommon Orthopedic Injuries

We rarely discuss medico-legal issues on EM Cases because it misguides us a bit from good patient centered care – which is what emergency medicine is really all about.

Nonetheless, missed orthopedic injuries are the most common reason for an emergency doc to be sued in Canada. This is partly because missed orthopedic injuries are far more common than missed MIs for example, but it’s also because it’s easy to miss certain orthopedic injuries – especially the ones that aren’t super common. And orthopedics is difficult to learn and remember for the EM practitioner as there are so many injuries to remember.

And so, you guessed it – on this episode we’re going to run through some key not-so-common, easy to miss orthopedic injuries, some of which I, personally had to learn about the hard way, if you know what I mean.

After listening to this episode, try some cognitive forcing strategies – for every patient with a FOOSH that you see, look for and document a DRUJ injury. Wait, hold on….I don’t wanna give it all away at the top of the post.

Let’s hear what EM doc and sports medicine guru Ivy Cheng, and the orthopedic surgeon who everyone at North York General turns to when they need help with a difficult ortho case, Hossein Medhian, have to say about Commonly Missed Uncommon Orthopedic Injuries.

Written Summary & Blogpost written and prepared by Keerat Grewal and Anton Helman, Oct 2014

Cite this podcast as: Cheng, I, Medhian, H, Helman, A. Commonly Missed Uncommon Orthopedic Injuries. Emergency Medicine Cases. October, 2014. https://emergencymedicinecases.com/episode-52-commonly-missed-uncommon-orthopedic-injuries/. Accessed [date].

Go to part 2 of this 2-part podcast on commonly missed uncommon orthopedic injuries



Quick Reference Cards for each injury discussed in this episode (click on card to view pdf)

Ch1 Lisfranc Injuries

Ch 2 Perilunate Injuries

Ch3 DRUJ injuries

Ch4 Pelvic Apophyseal Injuries



Lisfranc Injuries - Commonly Missed Uncommon Orthopedic Injuries



Question 1: What is a Lisfranc injury?



Lisfranc injuries are a spectrum of injuries, from a simple sprain to complete disruption of the tarso-metatarsal joints in the midfoot. These typically occur at the base of the 2nd metatarsal. Lisfranc injuries are easy to miss because they are very uncommon and because the x-ray findings are often subtle or even absent on standard views. Low velocity injuries are typically more commonly missed than high velocity ones. It's these subtle, low velocity injuries that we should be on the look out for.