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The circumstances surrounding an acute orthopedic injury influences the nature and duration of the initial examination. Consider the ambulatory evaluation, characterized by the patient coming to you for care on the sidelines. In many cases, this examination process mimics that described in Chapter 1. As used in this text, an acute examination is one that occurs immediately following the onset of the injury, often on the court or field. The acute examination initially focuses on determining the absence of severe injury, progresses through a series of examination techniques designed first to identify gross pathology, establishes the patient's ability and willingness to move and bear weight, and finally, if indicated, ends with a decision regarding return to play.

This chapter focuses on the immediate management of orthopedic pathology. Other possible emergent conditions, such as anaphylaxis, myocardial infarctions, and other medical conditions, that may require emergency interventions are not covered.

The first goal of the immediate examination is to determine if the condition requires emergency management to save the patient's life or extremity. In order of their importance, the immediate examination must rule out:

  • Inhibition of the cardiovascular and respiratory systems (i.e., whether or not the person is breathing and has a pulse)

  • Life-threatening trauma to the head or spinal column

  • Profuse bleeding

  • Fractures

  • Joint dislocation

  • Peripheral nerve injury

  • Other soft tissue trauma

Based on the findings of this triage, the immediate disposition of the patient must be determined. The acute management of the injury, the safest method of removing the athlete from the field, and the urgency of referral for further medical care are the focus of the decision-making process.

On-field examinations are best performed with two responders. In cases of head or spine trauma, one individual is responsible for stabilizing the cervical spine, while the other performs the needed examination techniques. For noncatastrophic conditions, one responder conducts the examination while the other communicates with and calms the athlete and controls the surrounding scene (Fig. 2-1). In all cases, the responders should ensure that play has stopped (or has been moved in the event of a practice-related injury) so that the responders and the victim are protected from further sports-related activity.


On-field examination performed by two responders. One responder communicates with and calms the athlete while the second performs the examination. This method is optimal for handling on-field injuries, especially in emergency situations.

When one responder is responsible for the on-field injury examination, a clear communication and examination protocol is needed so that relatively untrained people can assist (Fig. 2-2). The coaching staff and other personnel should receive regular training in cardiopulmonary resuscitation (CPR), including use of an automated external defibrillator (AED), and be prepared to provide assistance in the event of a ...

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