Although most providers are familiar with orthopedic injuries in the ED, some less-common conditions can be tough to identify but have significant consequences if not diagnosed and treated promptly. In his presentation, “High-Risk Orthopedic Injuries,” Andrew Perron, MD, FACEP, professor and residency director at the Maine Medical Center Department of Emergency Medicine in Portland, will discuss six orthopedic injuries associated with a high risk of disability or complication. Dr. Perron, who has has been giving this talk for several years, notes that these high-risk injuries are often overlooked due to the volume of orthopedic injuries presenting in the ED.

“We all do ortho all day long in the emergency department,” Dr. Perron said, “but there are a few things that we see rarely or that you’ll see once or twice in your career.” Dr. Perron will discuss the suboptimal outcomes that can result from misdiagnosis or lack of prompt treatment of these high-risk injuries.

“If you miss a posterior shoulder dislocation for long enough, that person needs a shoulder replacement,” he said. “If you leave a hip dislocation out long enough, [that person] is probably going to get avascular necrosis and need a new hip.” A few hours can make all the difference in outcomes.

“On a knee dislocation, if there’s vascular injury, the clock is ticking,” Dr. Perron advised. “If you get them revascularized in four to six hours, there’s a 15 percent chance of losing a leg. If you get them revascularized in more than six hours, there’s an 85 percent chance of losing a leg. That’s a big swing.”

Ultimately, high suspicion, careful examination, and appropriate testing and X-rays are the keys to catching these conditions in time, Dr. Perron said. “You’ve just got to know what it is when you see it and then do the right thing with it.”

Michael O’Neal is a writer based in New Jersey.