Ortho Stuff

Ortho Stuff: Just the Tips

Feb. 16, 2024

Orthopedic injuries might seem more straightforward than your average undifferentiated weak-and-dizzy presentation in the emergency department. But don't be fooled! Learn some key sports medicine tips from Washington Capitals physician Landon Mueller, MD, and EMRA*Cast's Will Smith, MD.


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Will Smith, MD

Emergency physician in Northern California
Graduate, Nuvance Health/Vassar Brothers Medical Center Residency
@WTSmithMD | wtsmithmd
EMRA*Cast Episodes


Landon Mueller, MD

Assistant professor, Georgetown University
Airway physician, Washington Capitals
Team physician, Old Glory Rugby and Marymount University


With the high volume and acuity that we face in the ED, sometimes patients with orthopedic injuries can be the welcomed low-hanging fruit that allows us to not only pick up another patient, but also catch our breath; imaging result = dispo. Unfortunately, that is a very easy trap to fall into because if we aren't looking for the right thing or using the right modality to do so, we may be inappropriately discharging patients with fractures that have high rates of mortality. In this episode, Dr. Landon Mueller gives us some good pearls on when to image, how to image, and what to do if our clinical suspicion is not matching up with the official radiology read.


  • MRIs are the gold standard when it comes to diagnosing hip fractures
    • X-rays are still first-line, but can miss a fracture up to one-third of the time
    • CT imaging can be up to 90% sensitive in finding a hip fracture
  • If you have a traumatic arthrotomy, skip the saline injection and order a CT; your patient will thank you!
  • When there is suspicion for a bimalleolar/trimalleolar fracture, X-rays are good enough to determine treatment in the ED; however, CT imaging may be useful when determining definitive care with ortho/podiatry


  1. Sedigh Haghighat S, Hsu R, Berberian JG. EMRA Ortho Guide. 1st ed. Emergency Medicine Residents' Association; Dallas, TX. 2019.
  2. Brady MF, Stader DE. EMRA and AAED Nerve Blocks and Procedural Pain Management Guide. 1st ed. Emergency Medicine Residents' Association; Dallas, TX. 2023.
  3. MobilEM on-shift mobile app for emergency medicine management. Ortho Guide module.
  4. EMRA RA mobile app for procedural pain management. App Store.

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