Intro/Fractures

Question 1

Canadian C-spine Rules

Answer 1

High risk factor - age >/= 65 or dangerous mechanism or paresthesias in extremities = yes

Low risk factor - simple rear-end MVA or sitting in ED or ambulatory at any time or delayed neck pain or absence of midline c-spine tenderness = no
- If low risk yes, but can’t rotate neck 45 deg L and R = imaging needs to be done
- If low risk yes and can rotate neck 45 deg L and R = no imaging

Question 2

Ottawa Knee Rule

Answer 2

• x-ray is required if any of these findings:

age 55 or older
or
isolated tenderness of patella (no bone tenderness of knee other than patella)
or
tenderness of head of fibula
or
inability to flex 90 deg
or
inability to bear weight both immediately and in the ED for 4 steps

Question 3

Ottawa Ankle Rules

Answer 3

A) x-ray required if any pain in malleolar zone and any of these findings:
- bone tenderness at posterior edge or tip of lateral OR medial malleolus
or
- inability to bear weight both immediately and in the ED for 4 steps

B) x-ray required if any pain in midfoot and any of these findings:
- bone tenderness at base of 5th metatarsal OR navicular
or
- inability to bear weight both immediately and in ED for 4 steps

Question 4

What color will air, fat, water, and bone be on x-ray?

Answer 4

air - black
fat - gray-black
water - gray
bone - white

more dense objects are lighter and less dense are darker

Question 5

What is arthrography?

Answer 5

• injection of contrast within joint space
• distends capsule
• outlines internal surfaces
• commonly used w/ CT, MR, fluroroscopy

Question 6

What is myelography?

Answer 6

• pertaining to spinal cord, dura mater, and nerve root
• injected in cerebrospinal fluid (subarachnoid space)
• column of radiopaque fluid
• may be administered w/ CT

Question 7

best clinical application and limitations of CT

Answer 7

Best clinical application
- fracture evaluation

Limitations
- detail cannot be enhanced
- difficulty with positioning
- exposure

Question 8

How to describe the alignment of a fracture?

Answer 8

description of distal segment in relation to proximal

Question 9

greenstick vs torus fracture

Answer 9

greenstick - fracture on side of tensile loading

torus - impaction fracture on side of compressive loading

Question 10

Pediatric Physeal Fractures Acronym

Answer 10

SALTR

Slipped
Above
Lower
Through
Ruined

Question 11

Type I pediatric physeal fracture

Answer 11

Slipped
- growth plate only

Question 12

Type II pediatric physeal fracture

Answer 12

Above
- Physis and metaphysis

Question 13

Type III pediatric physeal fracture

Answer 13

Lower
- Physis and epiphysis

Question 14

Type IV pediatric physeal fracture

Answer 14

Through
- Epiphysis, physis, and metaphysis

Question 15

Type V pediatric physeal fracture

Answer 15

Ruined
- crush injury of physis

Question 16

Type VI pediatric physeal fracture

Answer 16

Rang’s - involves perichondral ring or associated periosteum of physis

Question 17

Types VII - IX pediatric physeal fracture

Answer 17

Ogden’s - do not directly involve physis, though may disrupt blood supply

VII - osteochondral fracture of epiphysis
VIII - fracture of metaphysics
IX - avulsion of periosteum

Question 18

common immobilization/protection timelines

Answer 18

6-8 weeks for adults

4-6 weeks for children

Question 19

What does excessive loading risk of fractures cause?

Answer 19

risk for pseudoarthrosis

Question 20

possible complication of pelvic fracture

Answer 20

hemorrhage

Question 21

possible complication of femur fracture

Answer 21

hemmorrhage - occurs with closed fractures

Question 22

possible complication of multiple or crushing type fractures

Answer 22

fat embolism - develops 12-72 hours after fracture

Question 23

possible complication of elbow fracture

Answer 23

brachial artery injury - associated with Supra-condylar fractures

Question 24

possible complication of proximal humeral fracture

Answer 24

axillary nerve injury

Question 25

possible complication of shoulder dislocation

Answer 25

axillary artery injury, brachial plexus, axillary nerve injury - can be asymptomatic but later develop occlusion

Question 26

possible complication of elbow dislocation

Answer 26

brachial artery injury, median and ulnar nerve injury

Question 27

possible complication of hip dislocation

Answer 27

femoral artery or nerve injury

Question 28

possible complication of knee dislocation

Answer 28

popliteal artery injury or peroneal nerve injury

Question 29

What imaging techniques are required if trauma is expected?

Answer 29

C-Spine is critical
Extremities:
>/= 2 views that are 90 deg from each other
AP & lateral views when possible
Include joints adjacent to bones (given heightened concern for remote injury)