Orthopedics

As cancer incidence increases and treatment improves, more patients are living with cancer. Consequently, cancer-related orthopedic emergencies have become more prevalent. Issues specific to orthopedic oncologic emergencies are important for a variety of reasons. Patients with undiagnosed cancer can present to the emergency department with pathologic or impending pathologic fractures. With appropriate suspicion and diagnostic workup, proper management of these patients can be rendered and vital errors avoided. Oncology patients can present with open fractures or compartment syndrome, which for the most part adhere to general trauma principles, but the nuances of underlying malignancy demand appropriate modification by the emergency provider. Oncology patients are often immunocompromised and uniquely prone to infections. These range from less-emergent issues such as cellulitis or bursitis to more urgent problems such as necrotizing fasciitis. It is critical for emergency practitioners to recognize more aggressive infections, as quick intervention can mean the difference between life and death. As technology advances and limb preservation becomes more popular, inherent complications associated with joint arthroplasty will increase as well, including periprosthetic fractures and dislocations. Finally, with advances in complex pelvis surgery for sarcomas, more aggressive operations are being performed. These patients require special attention, as quick intervention can not only identify early infection and wound complications, but also prevent loss of limb.