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ER Part 2 > ORTHO > Flashcards

ORTHO Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Is everything in ortho able to diagnose with xrays?

A

No… duh

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2
Q

Where does a clavicle fracture typically occur?

A

Distal 1/3

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3
Q

What physical exam finding is of the biggest concern with a clavicle fracture?

A

Look at the skin! If you see tenting it will convert into an open fracture

And make sure they don’t hurt at the sternoclavicular joint

And no neuro findings!

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4
Q

How do you treat a clavicle fracture?

A

Should immobilizer & sleep upright if need be

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5
Q

What’s it called when there is shortening?

A

Beynnett

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6
Q

What are the grades of an AC joint separation?

A

Grade 1-3

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7
Q

How do you treat an AC separation?

A

sling

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8
Q

Who do most commonly see humeral head fractures in and what MOI?

A

elderly with FOOSH

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9
Q

How do we treat humeral head fractures?

A

Typically conservative

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10
Q

If you find a scapula injury, what do you need to think?

A

There is most likely other trauma

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11
Q

What should we never say after an xray?

A

Don’t say: “Everything is okay”. Say: “I do not see obvious bony injury BUT we can’t see soft issue injury”

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12
Q

What’s the MOI for a shoulder dislocation?

A

Abd & Ext rotation

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13
Q

What will you see on PE with a shoulder dislocation?

A

Sulcus sign that you can place your thumb into it

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14
Q

What should we rule out with a shoulder dislocation?

A

Fracture & neuromuscular and a Hill-Sachs deformity

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15
Q

What would cause a posterior dislocation in an unconscious patient?

A

Seizure and Electrocution

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16
Q

What’s a good pain medication for shoulder dislocations?

A

Fentanyl (since it wears off quickly)

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17
Q

What should we ask about in history for shoulder dislocations?

A

Ask about prior dislocations & how long it has been out for & which hand is dominant

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18
Q

If a patient has a hill-sachs deformity, how difficult is it to relocate?

A

VERY (will often need full sedation)

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19
Q

What image would prove shoulder relocation?

A

Y (with humeral head touching all 3 views)

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20
Q

Once the shoulder is reduced, what do you do?

A

post reduction films, recheck neurovascular, and tell them to avoid abd/ext rot

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21
Q

Limited flexion ROM (can’t go past 90 degrees) is key in what diagnosis?

A

Rotator cuff injury

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22
Q

how do you treat a RTC tear?

A

Sling → send to ortho

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23
Q

What are the common elbow fractures?

A

Supercondylar (bad)

Radial head

Olecranon

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24
Q

If you see a distal humeral fracture in a child – what do you do?

A

REFER!!!! It’s a supracondylar fracture that is so likely to produce long term effects

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25
Q

A sail sign is for what?

A

Proximal radial head fracture

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26
Q

When do we see a posterior fat pad in the elbow?

A

Only when there is an injury; again proximal radial head fracture

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27
Q

What type of splint for a proximal radial head fracture?

A

Long arm

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28
Q

Which way does an elbow dislocate?

A

Posterior

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29
Q

After an elbow reduction, what do you do?

A

Are they neuromuscular intact -

have radiologist or ortho confirm that there’s no radial head fx

30
Q

How do you reduce an elbow?

A

Countertraction, then pull out and flex forward

31
Q

What’s special about the scaphoid?

A

Limited blood supply → high rate of non-unions

32
Q

When do you need to handle a wrist injury rather than splinting and sending to ortho later?

A

Severely angulated or displaced

33
Q

What splint for a distal radius?

A

volar

34
Q

Any time you find a fracture in a two-bone structure what must you do?

A

Either crazy palpate or image higher up

35
Q

What fractures in the wrist/forearm do you not want to miss?

A

Monteggia or Galiazzi

36
Q

What does a positive finkelstein’s test?

A

DeQuervan’s

37
Q

What does a positive tinel’s test?

A

Carpal tunnel

38
Q

How do you treat carpal tunnel?

A

Splint day & night

39
Q

If a patient has a hyperextension injury of the thumb – what diagnosis?

A

Gamekeeper’s Thumb

40
Q

What must you test for gamekeeper’s?

A

MCL injury

41
Q

If a grandma fell and her hip hurts and she won’t walk – what does that mean? What should you do?

A

There is most definitely something wrong → most likely an acetabular fracture

CT hip

42
Q

What hip fracture is stable and the person can walk in on it?

A

Ramus or pelvic ring fractures

43
Q

If you break higher up in the crest portion of the hip – will they walk on it?

A

Nope

44
Q

What should you look for on PE in a pelvic fracture?

A

Crepitus, instability, weight bear, and rotation

45
Q

Shortened and internally rotated hip is what?

A

Dislocation

46
Q

What should you press onto to rule out significant injury in a pelvic injury?

A

Iliac crests – if you not crepitus → get trauma

47
Q

What parts of body can you bleed into?

A

Head, chest, pelvis, and femur

48
Q

Where is an open book fracture?

A

Pubic symphysis

49
Q

What do you need to make sure or with a pelvic fracture (downtown)?

A

Make sure there’s no tear in their urethra → no blood present

50
Q

What happens to hip fracture patients?

A

They get admitted

51
Q

What classification system can we use for hip fractures?

A

Garden classification

52
Q

If a patient cannot walk on their hip and their leg is externally rotated – what diagnosis is most likely?

A

Hip fracture

53
Q

Who would most commonly dislocate their hip?

A

total hip patients

54
Q

Which way do most hips dislocate?

A

Posterior

55
Q

How do you manage a femur fraction in the ED?

A

Traction splint (Hare) → Surgical fixation is always necessary

56
Q

If you have a patient with a suspected femur fracture, what must you remember?

A

Rule out any other injuries!!!

57
Q

If there is some type of neurovascular compromise in a femur fracture, what must you do?

A

Pull traction

58
Q

If you see a kid with a femur fracture – what must you suspect?

A

Child abuse

59
Q

If a patient presents with a plant and twist mechanism with minimal pain?

A

ACL

60
Q

PE findings of ACL tear?

A

+ Anterior drawer & + Lachman’s

61
Q

PE findings for meniscal tear?

A

joint line tenderness & + Valgus

62
Q

What is the meniscus connected to?

A

MCL

63
Q

IF you have a true knee dislocation – what do you do?

A

DO NOT DO ANYTHING WITH IT! Call ortho for EMERGENT consult

Why? Because of the popliteal artery, and you assume neurovascular accident

64
Q

We should ALWAYS check AROM in the knee – what are we ruling out?

A

Quad or patellar tendon rupture

65
Q

What is difficult about tibial plateau fractures?

A

easy to miss & often don’t heal well

66
Q

What must you always note on ankle xray?

A

Is the mortise intact

67
Q

Which ankle injury is most common?

A

Lateral malleolus

68
Q

If there is an ankle fracture what MUST you check, in order to rule out what?

A

DOCUMENT NO PROXIMAL TIBIAL TENDERNESS

In order to rule out a maisoneuve injury

69
Q

If you have a bi or tri-malleolar fracture what happen to the mortise joint?

A

It is unstable

70
Q

A positive Thompson test is for what?

A

Achilles rupture

71
Q

How do you splint an Achilles tendon rupture?

A

Full plantar flexion

72
Q

If you have a calcaneal fracture in the right side – what must you rule out?

A

ALWAYS x-ray the other foot

ALWAYS examine the spine!

ER Part 2 (7 decks)

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