08 | Common Orthopedic Emergencies with Dr Chuck Gomez and John Appel, PA (Part 1)

In this episode of PEM Chatt, we explore common pediatric orthopedic emergencies with Dr. Chuck Gomez, a pediatric orthopedic surgeon, and John Appel, PA, an experienced emergency medicine provider. We discuss why children's bones differ from adult bones, how this affects fracture patterns, and the best approaches for diagnosis and treatment. Our conversation focuses on upper extremity injuries, including forearm fractures, supracondylar fractures, lateral condyle fractures, nursemaid’s elbow, elbow dislocations, and clavicle fractures. We cover key clinical pearls, such as recognizing subtle fractures that may not appear on initial imaging and ensuring proper splinting techniques to prevent complications.

Along the way, Dr. Gomez and John share insights on pain management, including the ongoing discussion around NSAIDs and bone healing, as well as best practices for determining when orthopedic consultation is needed. They emphasize the importance of early recognition of serious fractures, such as Monteggia fractures, and the role of follow-up imaging in cases where occult fractures may become more apparent over time. The episode also highlights practical reduction techniques for nursemaid’s elbow and explains why certain fractures, like clavicle injuries, rarely require surgery despite their dramatic appearance on X-rays.

Resources Mentioned:

Radiographic Interpretation Guide: Dr. Stewart Braden’s Orthopedics PowerPoint – Includes imaging examples and tips for recognizing key fractures. https://www.scribd.com/document/792597792/Bradin-Orthopedic-Emergencies

Montagia Fracture Reference: Ensuring proper radial head alignment on imaging.

Pediatric Ortho Follow-Up Recommendations: General guidelines for when to refer and how soon.

Coming Next:

This was a two-part episode! Stay tuned next month for Part 2, where we’ll discuss lower extremity orthopedic emergencies, including:

• Femur and tibia fractures
• Ankle injuries in kids
• Slipped Capital Femoral Epiphysis (SCFE)
• Toddler’s fractures
• And more!