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Clin Med- P > EM- ortho emergencies > Flashcards

EM- ortho emergencies Flashcards

1
Q

most common location of clavicle fracture?

A

middle 1/3 (80% of the time)

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2
Q

what fracture accounts for 90-95% of birth fractures?

A

clavicle

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3
Q

which bone in the body is the last one to fuse?

A

clavicle (finally finishes at 22-25)

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4
Q

ED treatment of clavicle fracture?

A

sling and swath immobilization for 2 weeks (almost all are treated non-operatively, especially in kids)

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5
Q

when would you consider operative tx for clavicle fracture? (3)

A

open fracture, skin tenting, NV injury

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6
Q

what is the most common type of shoulder dislocation?

A

anterior (about 90%)

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7
Q

which type of anterior shoulder dislocation is most common?

A

subcoracoid- humeral head ends here

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8
Q

how do you check NV status with ant shoulder dislocation?

A
  • check radial pulse for axillary artery
  • sensation over lateral deltoid for axillary nerve (most common injury)
  • test wrist extension for radial nerve
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9
Q

how do you NOT reduce an ant shoulder dislocation?

A

DONT put pressure in the armpit (could injure the brachial nerve)

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10
Q

what is a common complication of closed ant shoulder dislocation reduction? why is this important?

A

humeral neck fracture- can lead to AVN (why its important to get post-reduction films)

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11
Q

if a patient has this along with their ant shoulder dislocation, then you notify ortho upon consult

A

bankart lesion- disruption of anteroinferior portion of labrum or inferior part of bony glenoid

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12
Q

ED Tx of anterior shoulder dislocation?

A

Reduction: get pre & post reduction films

Sling & swath for 2 weeks

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13
Q

besides procedural sedation & analgesia, what can you add before reducing an ant shoulder dislocation?

A

intraarticular lidocaine

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14
Q

most common reduction maneuver for ant shoulder dislocation?

A

traction counter- traction: gentle adduction with gentle lateral rotation

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15
Q

what is the most important thing to check NV status of post ant shoulder dislocation reduction?

A

axillary nerve

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16
Q

what are some causes of a post shoulder dislocation?

A

seizures, electric shock, trauma (MVC)

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17
Q

what is the indication on an XRAY of a post shoulder dislocation?

A

light bulb sign- due to internal rotation of humeral head

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18
Q

ED tx of post shoulder dislocation

A

closed reduction

2 weeks of sling and swath

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19
Q

what is a sign of a nondisplaced supracondylar elbow fracture on an XRAY?

A

presence of a posterior fat pad sign (joint effusion of fluid, blood or pus)

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20
Q

what is the classification system for supracondylar elbow fractures?

A

Gartland
type 1: hairline crack transverse through humerus
Type 2: displaced anterior wall
type 3: complete displacement (both ant and post wall)

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21
Q

what is the most common peds elbow fracture?

A

supracondylar fracture

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22
Q

ED tx of lateral condyle fracture?

A

long arm cast for 4-6 weeks

if greater than 2mm displacement then operative & consult ortho

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23
Q

which type of lateral condyle fracture is more unstable?

A

type 2 because fracture is into trochlear groove

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24
Q

why is lateral condyle fracture more dangerous?

A

higher risk of nonunion, malunion, and AVN

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25
Q

what is the adult equivalent of a supracondylar fracture?

A

radial head fracture

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26
Q

most common orthopedic injury?

A

distal radius fracture

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27
Q

most commonly missed fracture?

A

scaphoid

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28
Q

distal radial fracture: distal radius is _________ angulated to the proximal radius

A

dorsally

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29
Q

monteggia vs galeazzi fracture

A

monteggia: proximal 1/3 ulnar fracture with associated radial head dislocation
galeazzi: distal 1/3 radius shaft fracture + DRUJ injury (distal radial-ulnar joint)

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30
Q

TX of distal radial fractures?

A

usually ortho right away: ORIF of radius + reduction and stabilization of DRUJ injury

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31
Q

what is important to push on every time you check for a wrist injury?

A

push on scaphoid

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32
Q

ED tx of scaphoid?

A

thumb spica splint and call ortho (displacement over 1mm = ORIF)

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33
Q

what ABX do you give to prevent infection in a fight bite?

A

augmentin

34
Q

ED tx of metacarpal fractures?

A

splint it and let ortho decide if angulation is appropriate

35
Q

what is acceptable angulation for the fingers?

A

index & long finger- 10 to 20
ring finger- 30
little finger- 40

36
Q

what is the most common injury to the skeletal system?

A

phalanx fractures

37
Q

what is important to check during exam for phalanx fractures?

A

tendon function- injury is often near tendon insertion site

38
Q

ED tx for phalanx fractures?

A

early mobilization: buddy loops and outpatient follow-up

ORIF/CRPP for unstable irreducible fractures

39
Q

Tuft’s fracture: where is the fracture located? how to tx?

A

distal phalanx

assess nail bed (maybe repair) and almost always non-op

40
Q

ED tx of phalanx dislocations?

A 
reduce finger (usually only takes a slight pull)
*do a digital block beforehand
and then splint for 6-8 weeks
41
Q

ED tx of hip fractures

A

image hip & make sure nothing else will kill them…pain meds and call ortho

42
Q

what is the prognosis of elderly after having a hip fracture?

A

one yr mortality post fracture is 25-30%

43
Q

which type of hip dislocation is most common?

A

posterior

44
Q

ED tx of hip dislocation?

A

1) . attempt reduction in ED under conscious sedation
2) . post-reduction CT to rule out femoral head fractures
3) . protected weight bearing following reduction for 6 weeks

45
Q

when do you not need post reduction films after hip dislocation?

A

when the pt has had a total hip replacement and acetabulum is made of titanium

46
Q

distal Tib/Fib fracture classification

A

Weber- level of fibular fracture relative to syndesmosis
A= below syndesmosis
B = level of syndesmosis
C = above level of syndesmosis

47
Q

ED tx for distal tib/fib fracture

A

if isolated nondisplaced malleoli fracture- conservative tx with short leg walking cast vs boot
displacement of isolated fracture, open, or bimalleolar fracture- ORIF

48
Q

what is the maisonneuve fracture?

A

spiral proximal fibular fracture & distal medial malleolar fracture (and/or deltoid ligament rupture) which COMPROMISES SYNDESMOSIS

49
Q

tx of maisonneuve fracture?

A

it is unstable so surgical fixation is required

50
Q

if you have a distal ankle fracture, what is also important to examine?

A

fibular head!

51
Q

ED tx of tibial plateau fractures?

A

knee immobilizer

52
Q

ED tx of high ankle sprain

A

sprain w/o diastasis or ankle instability = non weight bearing CAM boot or cast for 2-3 weeks
if syndesmosis is unstable = SURGERY

53
Q

ED tx of subtalar dislocation?

A

closed reduction FIRST (sedation and post reduction films)

*open reduction if failed attempt at closed reduction

54
Q

tibiofemoral dislocations: fracture of what in 60% of cases?

A

tibia +/- femur

55
Q

what is the dimple sign?

A

buttonholing of medial femoral condyle through medial capsule during a tibiofemoral dislocation

56
Q

dislocated knees always get what test?

A

vascular studies (ABI AND arteriogram) to evaluate popliteal artery injury; consult vascular if found

57
Q

ED tx of knee dislocation?

A

1) . get vascular studies
2) . reduce knee and reexamine NV
3) . splint in 20-30 degrees of flexion (takes pressure off NV)
4) . post reduction films

58
Q

what is the leading cause of death in pelvic ring fracture?

A

hemorrhage

59
Q

if patient is hemodynamically unstable and has a pelvic fracture then what do you give them?

A

probably will need blood

60
Q

ED tx of pelvic fracture

A

place binder on them (goes over trochanter), give blood if needed and call ortho

61
Q

fat embolism is common in patients with what type of injury?

A

pelvis or long bone fractures (breaking bones causes marrow to be released into the bloodstream)

62
Q

fat embolism is more common in bilateral _______ fractures

A

femur

63
Q

treatment of fat embolism

A

prevention! by early fracture stabilization

64
Q

two major clinical signs of compartment syndrome?

A

pain out of proportion and pain on passive motion

65
Q

what striker pressure indicates compartment syndrome?

A

> 30

66
Q

tx for compartment surgery

A

call ortho bc emergent fasciotomy

67
Q

___% of low back pain resolves within one year of onset

A

90%

68
Q

red flags that are signs of severe back issue (2)

A

1) . saddle anesthesia or acute bowel/bladder incontinence (indicates cauda equina)
2) . constant severe pain that is worse lying down (infection or CA)

69
Q

ED Tx for cauda equina syndrome

A

call neurosurgery bc urgent surgical decompression within 48 hours

70
Q

ED tx for spinal epidural abscess

A

bracing and IV ABX (surgical decompression with neurosurgery)

71
Q

ED tx for open fractures

A

resuscitate, direct pressure, clean it up and place sterile saline dressing, splint, check NV status, START EMPIRIC ABX and call ortho

72
Q

why is it important to treat gonococcal arthritis FAST?

A

can destroy the joint in hours (immune system is causing the damage)

73
Q

gold standard for diagnosing septic joint?

A

joint fluid aspiration and culture

74
Q

septic joint: joint fluid aspiration results?

A

WBC > 50,000

cloudy or purulent fluid

75
Q

ED tx of septic joint

A

broad spectrum parenteral ABX after culture; once results back, then narrow down ABX
also irrigate and drain infected joint

76
Q

how does compartment syndrome happen?

A

there is an increased pressure in the closed fascial space which leads to decreased tissue perfusion and severe tissue damage

77
Q

where does compartment syndrome frequently happen?

A

anywhere skeletal muscle is surrounded by fascia

*leg, forearm, hand, foot, thigh, butt

78
Q

septic joint presentation

A

monoarticular, red, hot, tender and decreased ROM (knee most common)

79
Q

anterior shoulder dislocation MOA

A

abduction, external rotation and extension

80
Q

what movements are hard to do for a patient with an anterior shoulder dislocation?

A

adduction and internal rotation

81
Q

hip dislocation MOA

A

young people- high energy injuries

older people- low energy injury

82
Q

presentation of leg in hip dislocation

A

slight flexion, adduction and internal rotation

Clin Med- P (124 decks)

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