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INTRODUCTION

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Treating orthopedic and related soft-tissue injuries can be problematic when medical equipment is scarce, especially in settings with high levels of injury (e.g., wilderness, war) or where having a disability is a threat to survival (e.g., treks, battles, subsistence economies). Extremity injuries are the primary cause of injury-related disability in many countries, especially in the developing world.1 In developed countries, they account for about 6% of all adult emergency department visits.2

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The World Health Organization (WHO) has developed a list of essentials for treating extremity trauma at facilities with different levels of treatment capability throughout the world (see the “Facilities” section in Chapter 5). Table 32-1 suggests what equipment and skills may need to be improvised in situations of scarcity.

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TABLE 32-1Worldwide Essentials for Diagnosing and Treating Extremity Injuries
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This chapter discusses the diagnosis and treatment of fractures and dislocations, including emergency amputations.

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DIAGNOSIS OF FRACTURES, DISLOCATIONS, AND SOFT-TISSUE INJURIES

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Lacking radiographs or other imaging capability, clinicians need to rely on physical signs and symptoms to make presumptive diagnoses of fractures and dislocations. Table 32-2 lists the common signs and symptoms of fractures, with a comment about their diagnostic utility. Radiographs and ultrasound are included in the list to identify their relationship with the physical examination. Many factors affect the usefulness of imaging as a diagnostic tool, including its technical quality and the skill of those interpreting the images.

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TABLE 32-2Usefulness of Clinical Information for Diagnosing Fractures (10 = Most Useful, 1 = Least Useful)

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