Orthopedic Emergencies: When to Call the Office

August 4, 2010

Orthopedic emergencies are those conditions that should be seen by a physician that day to prevent potential harm to the patient.

                  In today’s column we will not be talking about major trauma with deep lacerations, loss of consciousness, and fractures that obviously demand an immediate visit to the hospital ER.    We will focus on conditions that develop with little or no trauma and often in the home.

                  Unfortunately, the intensity of one’s pain only loosely correlates with the gravity of the condition.   For instance, consider the person with low grade shoulder pain that slowly becomes almost incapacitating.  This is most likely acute bursitis which, though very painful, is not dangerous.  Contrast this with a woman who feels fine one week after total knee replacement but wakes up to discover that her dressing is soaked with blood and joint fluid. This is an emergency because it could lead to a joint infection.

                  The following are conditions that orthopedists consider emergencies which should prompt an immediate call to the physician.

  1. Shortness of breath, chest pain, and cough occurring one to three weeks after total knee replacement, total hip replacement, or hip fracture surgery.  This could mean a blood clot to the lungs (pulmonary embolus).
  2. Onset of calf pain and swelling a few days or weeks after injury or surgery on the lower extremity.  This could be due to a blood c lot in the deep veins of the leg which might become an embolus to the lung.
  3. A wound in a post operative patient that spontaneously starts to drain.
  4. Acute onset of a painful swollen joint accompanied by fever and chills.  This could be due to a joint infection.
  5. Increasing pain, swelling, and numb fingers or toes in a patient with a solid cast.  This could be cast compression syndrome.
  6. Acute severe back pain often accompanied by weakness in the legs and inability to empty one’s bladder after lumbar spine surgery or epidural spinal injection.   This could be due to bleeding around the spinal cord.
  7. A child with a fracture, especially of the elbow, who has been treated for the fracture but remains uncomfortable and fussy despite medication.  This could mean dangerous swelling at the fracture sight.
  8. Any child who is crying, fussy, feverish and refuses to walk, without a definite injury. This could indicate a hip joint infection.
  9. Any post operative patient who accidently falls or twists the operative limb and then experiences a marked increase in pain.   This could mean a change in the fixation of the fracture, a new fracture, or, in the case of a total hip replacement, dislocation of the hip joint.
  10. Any person with osteoporosis (usually a post menopausal woman) who has groin or thigh pain even after minor injury, followed by inability to walk. This could mean an insufficiency (osteoporotic) fracture of the hip.

This “top ten” list is not complete, but it does highlight common orthopedic emergencies.  There are many other serious and painful orthopedic conditions not included on this list that should be seen by the orthopedist as soon as possible.  If you are unsure, call your orthopedist.