EM Ortho 1: Generalities, part 1

Question 1

example of stress fractures

Answer 1

metatarsal shaft fracture in unconditioned foot soldiers
“march fracture”

Question 2

what are salter fractures?

Answer 2

fractures involving the physis, the cartilaginous epiphyseal plate near the ends of the long bones of growing chilldren

Question 3

most predominant aspect of fracture healing

Answer 3

reparative phase

(the 3 phases: inflammatory, reparative, remodeling)

Question 4

remarks on fracture lines

Answer 4

some hairline fractures do not appear on a radiograph until days after injury

invisible initially, the diagnostic fracture line appears only after necrotic bone has been resorbed from the area

Question 5

remarks on dislocation

Answer 5

the longer a joint has been dislocated, the more difficult it may be to reduce and the less stable the reduction is likely to be

partly due to:
-edema
-muscle spasm

Question 6

classification system for open fractures

Answer 6

Gustilo-Anderson Classification

Question 7

GA grade I

Answer 7

low energy injury with an open wound <1 cm and no evidence of contamination

Question 8

GA grade II

Answer 8

moderate injury with comminution of fracture and a 1- to 10-cm wound with some contamination

Question 9

GA grade IIIA

Answer 9

high-energy fracture pattern with wound >10 cm and gross contamination

Question 10

GA grade IIIB

Answer 10

high-energy fracture with a >10 cm contaminated wound with exposed bone

Question 11

GA grade IIIC

Answer 11

high-energy fracture with a >10 cm contaminated wound with vascular involvement

Question 12

exception for sling and swathe

Answer 12

suspected anterior dislocation of the shoulder
-many pateints with this injury have difficulty aducting the forearm (painful)
-simple sling is adequate in such cases

Question 13

remarks on reducing deformity in the field

Answer 13

many EMS programs do NOT recommend prehospital reduction of an injured extremity, as injudicious manipulation may convert a pure dislocation to a fracture-dislocation

even if a fracture had already existed, there would be no way to prove it was not caused by the manipulation

may be justified if there’s a nonpalpable distal pulse

Question 14

imaging decisions should be based not only on the chief complaint, but also on

Answer 14

systematic palpation, observation of subtle deformity or signifianct point tenderness, and mechanism of injury

Question 15

some injuries might not be radiographically apparant on the first day, regardless of what views are taken, common examples are:

Answer 15

MaRS

Metatarsal stress fracture
Radial head nondisplaced fracture
Scaphoid fracture

In such cases, the diagnosis of fracture may be purely clinical until 7 to 10 days after trauma, when enough bony resorption has occurred at the fracture site to reveal a lucency on plain radiographs

Question 16

shoulder injury + dysphagia

Answer 16

posterior sternoclavicular dislocation
-causes pressure on mediastinal structures
-often can be demonstrated only by CT

Question 17

these suggest the possibility of an occult or easily missed fracture

Answer 17

exquisite tenderness to palpation
pain on weight bearing or passive range of motion

Question 18

pathognomonic for fracture

Answer 18

gross deformity along the shaft of a long bone

Question 19

these suggest dislocation or fracture near a joint

Answer 19

deformity at a joint
loss of range of motion
severe pain at rest

exception: posterior dislocation of shoulder
-although intensely painful, might not be accompanied by obvious deformity, although the humeral head may be palpated posteriorly