Fractures

Question 1

List the general approach to fracture management

Answer 1

ABC MOVIES 
serial imaging (clinical suspicion more important that imaging) 
Analgesia
Antibiotics 
Brace/splint
Consult ortho 
Compartment syndrome 
Stick them with tetanus

Question 2

List three important things to document when assessing fractures

Answer 2

R or L handed 
Occupation/function 
Joint above and below
Neurovascular
Previous injury 
Tetanus status

Question 3

How would you treat these things differently

1. Someone who had a tetanus shot five years ago cuts themselves on a kitchen knife
2. Someone who had a tetanus shot five years ago cuts themselves on a rusty nail
3. Someone who hasn’t had a tetanus shot cuts themselves on a kitchen knift
4. Someone who hasn’t had a tetanus shot cuts themselves on a rusty nail

Answer 3

1. Do nothing
2. Do nothing
3. Give them a tatanus shot
4. Give them tatanus immunoglobulins

Unknown status=unvaccinated

Question 4

Ottawa foot, knee, and ankle rules

Answer 4

Foot:
Pain over navicular or base of 5th metatarsal
Unable to wt. bear 4 steps immediately and in ED (Limping okay)

Ankle:
Pain over posterior aspect of distal 6 cm of lateral or medial Malleoli
Unable to wt. bear 4 steps immediately and in ED (Limping okay)

Knee: 
>55
Isolated patella tenderness
Tenderness at fibular head 
Unable to bend to 90 degrees
Unable to Wt. bear 4 steps immediately and in ED (limping is okay)

Question 5

You’re in ED and someone comes in with a fracture. You give them Toradol for pain management and consult ortho. Old man ortho guy comes and yells at you for giving a fracture patient and NSAID. What do you say back to them

Answer 5

Recent evidence that NSAIDS do not delay fracture healing and we should be avoiding opioids. Learn something new old man ortho.

Question 6

List five early and five late complications of fractures

Answer 6

1. Compartment syndrome 
Vascular injury
Neurological injury
Infection 
Pain 
DVT 

2. Mal union 
AVN
Osteomyelitis
Heterotrophic ossification
Arthritis

Question 7

List three fractures that may not show up on imaging and what to do

Answer 7

Scaphoid
Elbow
Growth plate
Stress fractures

Could do MRI or just sprint

Question 8

How to manage hip fractures

Answer 8

Analgesia, consider femoral nerve block

Surgery within 24 hours ideally

Question 9

Someone had a little stumble and broke a bone, What should you be thinking about

Answer 9

Patha logical fracture
MM
Mets
Osteoporosis

Ask about fractures
B symptoms
Night pain

Question 10

List four types of fractures that are concerning for abuse

Answer 10

Femur fracture 12-18 months 
Humerus fracture <18 months 
Skull fracture 
Metaphyseal (bucket handle) fracture 
Posterior rib fractures 
Multiple fractures in different stages of healing 
Fracture but not ambulatory

Question 11

What is saltter haris

Answer 11

Slipped
Above
Lower
Through
Rammed

Question 12

Who do the C-Spine rule apply to

Answer 12

Stable patients with GCS 15
Injury in the past 2 days
Over 16 years old

Question 13

When to x ray based on c spine rules

Answer 13

Age >65
Dangerous mechanism (fall over 5 stairs, MCV ?100 km per hour, struck on bike) 
Paresthesias
MCV more than rear end collision 
Not sitting up in the ER
Not ambulating at any time 
No delayed onset of the pain 
Any midline C spine tenderness
Not able to rotate neck to 45 degrees bilaterally