CA ortho injuries

Question 1

what are the 2 most commonly injured blood vessels?

Answer 1

femoral and popliteal

Question 2

what are the 2 most common causes of penetrating trauma?

Answer 2

gunshot wounds and stab wounds

Question 3

which type of penetrating trauma (gunshot vs. stab) involves a larger extent of tissue damage, with a wide range of pattern of injury?

Answer 3

gunshot wounds

stab wounds are most straightforward with a predictable pattern of injury

Question 4

what are 5 signs of vascular injury in your trauma patient?

Answer 4

1) diminished distal pulses
2) expanding/pulsatile hematoma
3) audible bruit
4) palpable thrill
5) distal ischemia (pain/pallor/paralysis/paresthesias, coolness)

Question 5

what should you do in the following circumstances:

1) believe vascular injury is DEFINITE
2) highly suspect vascular injury
3) no sign of vascular injury

Answer 5

definite = immediate vascular surgery consult

suspect = CT angiography

no signs = ABI to reassure

Question 6

what lab must you draw prior to performing CT angiography with contrast?

Answer 6

creatinine

Question 7

what lab should you order if there is significant blood loss associated with the trauma?

Answer 7

CBC

Question 8

which type of dislocations spontaneously reduce when you straighten the leg?

Answer 8

patellar dislocations

Question 9

a PARTIAL disruption of a joint is also known as what?

Answer 9

subluxation

Question 10

____ is a tearing injury to the muscle fibers, while ____ is a tearing injury to the ligaments of a joint

Answer 10

strain = muscle

sprain = ligaments

Question 11

what are the 4 orthopedic emergencies?

Answer 11

1) open fracture
2) subluxation or dislocation
3) neurovascular injury
4) compartment syndrome

Question 12

unilateral swelling and discoloration in the leg, pain out of proportion from injury, and unilateral decreased pulses should make you think what?

Answer 12

compartment syndrome

Question 13

since some injuries may not be radiographically evident on the first day, what testing should we consider?

Answer 13

CT or MRI to allow earlier dx

Question 14

when imaging your injured patient, what must you be sure to do?

Answer 14

image joints above and below

Question 15

which part of the bone, if fractured, is impossible to see on x-ray?

Answer 15

cartilage breaks

Question 16

bilateral compression of the shoulders leads to what type of injury?

Answer 16

anterior or posterior sternoclavicular dislocation

Question 17

direct blow to the medial clavicle leads to what type of injury?

Answer 17

posterior sternoclavicular dislocation

Question 18

fall, landing on apex of shoulder leads to what type of injury?

Answer 18

AC separation

Question 19

direct blow to anterior shoulder, FOOSH, seizure, or electroconvulsive muscular activity lead to what type of injury?

Answer 19

posterior dislocation of shoulder

Question 20

sudden traction force to toddler’s arm leads to what type of injury?

Answer 20

nursemaids elbow (subluxed radial head)

Question 21

forced dorsiflexion of the wrist leads to what types of injury? (4)

Answer 21

1) fracture of scaphoid
2) lunate dislocation
3) perilunar dislocation
4) colles fracture

Question 22

striking the knee against the dashboard in a high-speed collision leads to what type of injury?

Answer 22

posterior dislocation of the hip

Question 23

landing flat on your feet from height leads to what type of injury? (4)

Answer 23

1) calcaneus fracture
2) tibial plateau fracture
3) acetabular fracture
4) vertebral compression fracture (MC lumbar)

Question 24

ankle inversion force leads to what type of injury? (2)

Answer 24

1) fracture of any of the three malleoli

2) fracture of base of 5th metatarsal

Question 25

rotary ankle force leads to what type of injury? (2)

Answer 25

1) fracture of any three maleoli

2) disruption of ATF ligament with proximal fibular fracture (maissoneuve’s injury)

Question 26

how is midfoot dislocation (lisfranc’s injury) typically caused?

Answer 26

inversion or medial or lateral stress to the forefoot; axial load on the metatarsal heads with the ankle plantarflexed

Question 27

what is pathognomonic for fracture?

Answer 27

gross deformity

Question 28

why should the area you palpate extend well beyond the location of the pain the patient complains of?

Answer 28

pain is very often referred

Question 29

what are the four things we can do in the ED prior to ortho consult in our ortho trauma patient?

Answer 29

1) control pain and swelling (drugs, elevate above heart)
2) withhold oral intake if surgery
3) reduce fracture deformity
4) reduce dislocation

Question 30

why do we reduce fracture deformities? (4)

Answer 30

1) alleviate pain
2) relieve tension on nerves or vessels
3) minimize possibility of converting closed FX into open FX
4) restore circulation if pulseless

Question 31

what must you be sure to do prior and after dislocation reductions?

Answer 31

check neurovascular supply and get pre and post-reduction x-rays

Question 32

when do we splint? (2 occasions)

Answer 32

fractures and after reduction of dislocated joint

Question 33

a shoulder immobilizer is appropriate for which 4 conditions?

Answer 33

1) clavicle fracture
2) AC separation
3) shoulder dislocation
4) humeral neck fracture

Question 34

an arm sling is appropriate for which condition? (1)

Answer 34

non-displaced radial head fracture

Question 35

a long-arm gutter splint is appropriate for which 2 conditions?

Answer 35

1) elbow fracture

2) elbow dislocation

Question 36

a sugar-tong splint is appropriate for which 2 conditions?

Answer 36

1) write FX

2) forearm FX

Question 37

a short-arm gutter splint is appropriate for which 2 conditions?

Answer 37

1) metacarpal FX

2) proximal phalanx FX

Question 38

a thumb spica splint is appropriate for which 3 conditions?

Answer 38

1) scaphoid FX

2) thumb FX (metacarpal or proximal thumb phalanx)

Question 39

a knee immobilizer is appropriate for which 4 conditions?

Answer 39

1) patellar FX or subluxation
2) knee dislocation
3) tibial plateau fracture
4) knee ligament or meniscus injury/tear

Question 40

a posterior ankle mold splint is appropriate for which 4 conditions?

Answer 40

1) ankle dislocation or fracture
2) unstable ankle fracture (ie high fibular fx or medial and/or posterior malleolar)
3) widened medial mortise
4) metatarsal FX

Question 41

an ankle stirrup is indicated for which 2 conditions?

Answer 41

1) simple ankle sprain

2) stable lateral malleolar FX

Question 42

a hard-soled shoe is indicated for which conditions?

Answer 42

toe fracture, some metatarsal fractures

Question 43

a short leg walking boot is indicated for which types of conditions?

Answer 43

some toe or foot fractures where weightbearing is allowed

Question 44

what is a fat embolus?

Answer 44

delayed complication of extremity injury; fat embolus usually originating in marrow of FX of large bone can result in fatal respiratory failure

Question 45

what is malunion?

Answer 45

when an injury heals with a deformity