09 | Common Orthopedic Emergencies with Dr Chuck Gomez and John Appel, PA (Part 2)

PEM Chatt

Episode Summary:

In this two-part series, we sit down with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, a seasoned emergency medicine provider, to discuss common pediatric orthopedic emergencies. In Part 1, we cover upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. Dr. Gomez and John share insights on pain management strategies, splinting techniques, and key imaging considerations, ensuring listeners know when to consult orthopedics and how to manage common injuries.

In Part 2, we shift focus to lower extremity orthopedic emergencies, covering conditions such as Slipped Capital Femoral Epiphysis (SCFE), patella dislocations, tibial tubercle fractures, toddler’s fractures, and osteomyelitis/septic arthritis. Dr. Gomez provides guidance on recognizing urgent injuries, including red flags for compartment syndrome and infections, while John shares practical advice for ER-based assessment and initial management. Throughout the discussion, we emphasize when to splint, when to allow weight-bearing, and when orthopedic consultation is critical.

Resources Mentioned:

• Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedic PowerPoint – Includes imaging examples and fracture patterns. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies
• Ortho References: OrthoBullets for quick reference, UpToDate for evidence-based management, and pediatric orthopedic textbooks for deeper dives.
• Pain Control & NSAID Debate: Recommendations on NSAID use in fractures and multimodal pain management approaches.
• Septic Joint & Osteomyelitis Workup: Review of inflammatory markers, bedside ultrasound utility, and joint aspiration protocols.
• Clinical Pearls for Fracture Management: Guidelines for splinting, weight-bearing restrictions, and follow-up timing.

Next Episode:

Join us next month as we talk with Dr. Whitney Buss about pediatric DKA management. As both a pediatric emergency physician and a Type 1 diabetic, Dr. Buss brings unique insights into how DKA presents in children, key management strategies, and common pitfalls to avoid. Don’t miss this deep dive into a critical pediatric emergency!

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