EM Ortho 2: Generalities, part 2

Question 1

remarks on palpation

Answer 1

may disclose areas of bony step-off and the precise location of point tenderness

the area palpated should extend well beyond the location of pain described by the patient, as the pain may be referred

only a meticulous palpation examination may protect the clinician from being misled by referred pain and missing crucial diagnosis

Question 2

injuries that may be associated with vascular disruption

Answer 2

dislocation of the knee (tibiofemoral joint))
fracture-dislocation of the ankle
displaced supracondylar fracture of the elbow and children

Question 3

possible mechanism of injury for posterior dislocation of the shoulder

Answer 3

direct blow to the anterior shoulder
FOOSA
seizure

Question 4

remarks on radial head fracture

Answer 4

MOI: fall, landing on the outstretched arm or with the elbow beneath the body

may be occult on initial radiograph

Question 5

injuries that one may get with forced dorsiflexion of the wrist

Answer 5

Scaphoid fracture
Lunate dislcoation
Perilunar dislocation
Colles’ fracture

Question 6

Maisonneuve’s injury

Answer 6

disruption of the anterior tibiofibular ligament with proximal fibular fracture

Question 7

remarks on Lisfranc’s injury

Answer 7

midfoot dislocation
MOI: inversino or medial or lateral stress to the forefoot;
axial load on the metatarsal heads with ankle plantar flexed

Question 8

injuries that may require special views or advanced imaging modalities in order to be visualized

Answer 8

Posterior shoulder dislocation
Acromioclavicular separation
Sternoclavicular dislocation
Scaphoid fracture

Acetabulum (Judet’s view)
Patella (sunrise view)
Foot and Ankle (stress views)

Question 9

fractures that may be undetectable on radiographs initially, even when special views are taken

Answer 9

Radial head fracture
Scaphoid fracture
Metatarsal shaft fracture

Question 10

how to describe radiographs

Answer 10

1. open vs closed
2. location
3. orientation of the fracture line
4. displacement and separation
5. shortening
6. angulation
7. rotational deformity
8. +/- dislocation / subluxation

Question 11

examples of orientation of fracture line

Answer 11

transverse
oblique
spiral
comminuted
segmental
torus
greenstick

Question 12

salter-harris fractures

Answer 12

type I: the entire epiphysis
tpe II: the entire epiphysis + portion of the metaphysis

type III: a portion of the epiphysis
type IV: a portion of the epiphysis + portion of the metaphysis

type V: compression injury of the epiphyseal plate (nothing is broken off)

Question 13

remarks on salter-harris fractures

Answer 13

type I - potential for growth disturbance is least
type V - worst prognosis
type I and V - may be radiographyically undetectable

Question 14

ED treatment for orthopedic injuries

Answer 14

1. control pain and swelling
2. withhold oral intake
3. reduce fracture deformity early
4. reduce dislocation
5. initially manage open fracures

Question 15

short-term benefits of reducing fractures

Answer 15

1. alleviating pain
2. relieving tension on nerves and vessels
3. preventing conversion to open fractures

Question 16

how to reduce deformity at or near the midshaft of a long bone

Answer 16

after the patient has been appropriately sedated, this is usually reduced with gradual, steady, longitudinal traction

Question 17

remarks on deformities in relation to joints

Answer 17

the nearer a deformity to a joint, the more difficult it may be to correct and dthe more specialized the reduction maneuver may have to be

Question 18

most imporant in management of open fractures

Answer 18

irrigation

Question 19

antibiotics in open fractures

Answer 19

Cefazolin (1st gen ceph)

+ aminoglycoside
when the wound is >10 cm with severe soft tissue inury and loss of bone coverage

+ penicillin (or mteronidazole, clindamycin, or vancomycin)
when there’s significant contamination by plants or soil for anaerobic coverage)

Question 20

disruption of the anterior tibiofibular ligament with proximal fibular fracture

Answer 20

Maisonneuve’s injury