214-Remote Orthopaedics with Dr Bob Dichiera

<p>In this episode of CoROM Conversations, <strong>Bill Vasios</strong> is joined by <strong>Dr Bob Dichiera</strong>, a retired US Army veteran with experience in operational medicine, primary care and orthopaedic surgery, and an associate professor at East Carolina University&#39;s PA programme. </p><p>Bob introduces a practical approach to remote orthopaedics built around four questions: <strong>Is the patient dying? Is a limb dying? Can I stabilise it? Does the patient need evacuation?</strong></p><p>The discussion examines the orthopaedic emergencies that clinicians cannot afford to miss, including open fractures and dislocations, neurovascular compromise, compartment syndrome, vascular injuries, pelvic fractures and traumatic amputations. Throughout the session, Bob emphasises repeated <strong>pulse, motor and sensory (PMS)</strong> assessment before and after interventions. </p><p>Using clinical cases, the conversation explores closed and open tibial fractures, field-expedient fracture assessment, compartment syndrome, irrigation and antibiotics, splinting, shoulder dislocations and reduction decisions. The discussion considers when reduction may be appropriate in a remote environment, particularly when prolonged transport is combined with neurovascular compromise.</p><p>The later discussion examines pelvic and hip injuries, field assessment, ultrasound and the difficult question of whether procedures such as fasciotomy have a role in genuinely remote care. Bob also considers how telemedicine and remote specialist support may extend what clinicians can safely accomplish in austere environments.</p><p><br></p><p><strong>00:00</strong> – Tuning-fork fracture diagnosis cold open</p><p><strong>00:18</strong> – Introduction to Remote Orthopaedics</p><p><strong>01:58</strong> – Why MSK injuries matter in remote medicine</p><p><strong>03:00</strong> – Orthopaedic emergencies you cannot miss</p><p><strong>04:18</strong> – Damage-control orthopaedics</p><p><strong>05:00</strong> – Is the patient dying? Is the limb dying?</p><p><strong>06:42</strong> – Closed tibial fractures</p><p><strong>07:40</strong> – Diagnosing fractures with a tuning fork</p><p><strong>09:06</strong> – Splinting and traction decisions</p><p><strong>11:31</strong> – Compartment syndrome</p><p><strong>14:00</strong> – Pain with passive stretch</p><p><strong>15:30</strong> – Open fractures</p><p><strong>16:20</strong> – Irrigation</p><p><strong>17:00</strong> – Antibiotics for open fractu