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We do reduce 'run of the mill' fractures on occasion, most commonly colles fractures.  I stay away

from any Salter fractures.    I also reduce  complex fractures that will require operative
intervention in multi-trauma patients before they go to CT or the OR or ICU as ortho will
generally not deal with these until the patients are stablized.

Regarding our colles fractures and the occasional both bones fracture - Generally if the ortho
resident is at home and a senoir resident who doesn't feel the need for the educational
opportunity I see little problem in reducing these as long as the understanding is if the
reduction isn't satisfactory than the ortho resident needs to come it and try again (rare).  We
learn this as part of our residency so I don't feel untrained.  I enjoy the opportunity to use
these skills reguarly. I think this probably compares more with an I+D of an abcess than an
appendectomy.

Virgil Davis




Martin Herman wrote:

> We do not reduce the fractures .
>
> Just curious, if your surgery coverage was spotty, would you guys learn to
> do appendectomies?
>
> Seriously, I would be careful about getting into that area of liability
> risk. The hospital is required to provide the specialty back up or they are
> in violation of COBRA and EMTALA. check it out Jay. Of course, there is
> nothing wrong with splinting for a reduction next AM if the fracture is
> closed, neurovascularly intact and the skin is not taught.
>
> Parents get spoiled and we feed into the  problem of inappropriate resource
> utilization ( having untrained ED docs reduce fractures when Orthpods could
> do it the next AM) by allowing them to make demands and then catering to
> those demands. I think your actions are an example of this. Proper fracture
> management does not require immediate reduction, .
>
> Marty
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html