Ortho&Trauma with Dr. Polotrauma

Elbow and forearm injuries are a daily reality in emergency care, and a few of them can threaten the limb. In this episode we break down the 2020 review by Hanlon and Mavrophilipos in Emergency Medicine Clinics of North America. The elbow is the second most commonly dislocated large joint in adults: 90% of dislocations are posterolateral, one in three carries an associated fracture, and ulnar nerve injury appears in 8% to 21% of posterior dislocations. We cover the four-way range of motion test that can rule out the need for radiographs, point-of-care ultrasound that detects as little as 1 to 3 mL of joint fluid, the Mason classification for radial head fractures, and the Monteggia pattern whose radial head dislocation is missed in 20% to 50% of first evaluations. We close with reduction techniques, splinting positions, and why immobilization beyond three weeks ruins outcomes.

The Emergent Evaluation and Treatment of Elbow and Forearm Injuries
Hanlon DP, Mavrophilipos V · Emergency Medicine Clinics of North America, 2020
https://doi.org/10.1016/j.emc.2019.09.005

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Gastrocnemius recession is a popular procedure to release isolated calf tightness, a recognized contributor to forefoot overload, plantar fasciitis, flatfoot and foot pain. But planning the incision by visual landmarks alone can be deceiving: calf shapes vary so much that the incision may be off by several centimeters, and cutting the underlying soleus effectively converts the operation into an Achilles lengthening. In this episode we review the technique described by Toomey and Seibert: a quick preoperative ultrasound scan, done in the holding area with the same machine used for nerve blocks, that reproducibly locates the gastrocnemius-soleus junction and allows a smaller, precisely placed incision with an isolated release of the gastrocnemius fascia. We also cover the supporting outcome data from cited series: pain scores improving from 8/10 to 2/10 with 93 percent satisfaction, peak torque recovering to 74 percent of the opposite limb by 18 months, and a 6 percent adverse event rate across 126 cases with all patients achieving a single limb heel rise at 6 months.

The Use of Ultrasound to Isolate the Gastrocnemius-Soleus Junction Prior to Gastrocnemius Recession
Toomey EP, Seibert NR · Foot and Ankle Clinics of North America, 2014
https://doi.org/10.1016/j.fcl.2014.08.008

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When a partial knee replacement becomes infected, surgeons must decide whether to remove the implant or try to save it. This episode reviews a systematic review and meta-analysis on debridement, antibiotics, and implant retention for periprosthetic joint infection after unicompartmental knee arthroplasty. Pooling nine studies and 165 patients from several countries, the authors found that the implant-saving approach achieved an infection-free survival of 72 percent, with all-cause implant survival around 67 percent. However, roughly one in three patients eventually required conversion to a total knee replacement, and about one in six needed a repeat debridement. Staphylococcus aureus was the most common infecting organism, found in about 39 percent of cases, and most infections were acute. The evidence comes mainly from small case series, so quality is limited, but the message is practical: for an acute infection with a well-fixed implant, DAIR is a reasonable first-line treatment, provided patients are counseled honestly about the real chance of further surgery.

Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection after Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis
Bałoniak A, Jancevski T, Campos Martins E · The Journal of Arthroplasty, 2026
https://doi.org/10.1016/j.arth.2026.05.035

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Periprosthetic joint infection after unicompartmental knee arthroplasty is rare but serious. In this episode we break down the first meta-analysis focused only on debridement, antibiotics, and implant retention, or DAIR, in this setting. Pooling 9 studies and 165 patients, the authors report pooled infection-free survival of 72 percent and all-cause implant survival of 67 percent. We discuss why the Kaplan-Meier estimate of 62 percent may better reflect long-term reality, why about one in three patients still convert to total knee arthroplasty, and why Staphylococcus aureus, found in 39 percent of cases, calls for rapid organism identification and biofilm-aware antibiotics. The takeaway: in well-selected acute infections, DAIR is a reasonable first-line option, and a partial knee implant alone does not justify routine escalation to total knee conversion.

Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection after Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis
Bałoniak A, Jancevski T, Campos Martins E · The Journal of Arthroplasty, 2026
https://doi.org/10.1016/j.arth.2026.05.035

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Opioids have classically been the mainstay of pain control on the trauma ward, but they offer only moderate efficacy while carrying serious risks, including addiction and adverse events that raise mortality and length of stay. This episode reviews the non-opioid alternatives for both simple limb trauma and complex poly-trauma. We walk through the evidence on topical agents, acetaminophen, anti-inflammatory drugs, gabapentinoids, intravenous lidocaine, ketamine, dexmedetomidine, peripheral nerve blocks, and the newer fascial plane blocks. The classic efficacy data is striking: ibuprofen outperforms oxycodone on number needed to treat, and pairing an anti-inflammatory with acetaminophen roughly doubles the opioid-sparing effect. The authors close with a practical, stepwise algorithm separating first-line and second-line analgesics, tailored to each patient, so opioids become the rescue rather than the foundation.

Pain management in the orthopaedic trauma patient: Non-opioid solutions
Gessner DM, Horn JL, Lowenberg DW · Injury, Int. J. Care Injured, 2020
https://doi.org/10.1016/j.injury.2019.04.008

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Opioids have classically been the mainstay of pain control on the trauma ward, but they offer only moderate efficacy while carrying serious risks, including addiction and adverse events that raise mortality and length of stay. This episode reviews the non-opioid alternatives for both simple limb trauma and complex poly-trauma. We walk through the evidence on topical agents, acetaminophen, anti-inflammatory drugs, gabapentinoids, intravenous lidocaine, ketamine, dexmedetomidine, peripheral nerve blocks, and the newer fascial plane blocks. The classic efficacy data is striking: ibuprofen outperforms oxycodone on number needed to treat, and pairing an anti-inflammatory with acetaminophen roughly doubles the opioid-sparing effect. The authors close with a practical, stepwise algorithm separating first-line and second-line analgesics, tailored to each patient, so opioids become the rescue rather than the foundation.

Pain management in the orthopaedic trauma patient: Non-opioid solutions
Gessner DM, Horn JL, Lowenberg DW · Injury, Int. J. Care Injured, 2020
https://doi.org/10.1016/j.injury.2019.04.008

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma