Orthopaedics & Rheumatology \ Fractures and Dislocations

Question 1

What symptoms are suggestive of a fracture in a patient?

Answer 1

• Swelling
• pain with movement
• deformity
• functional impairment
• focal bony tenderness

Question 2

If a person has a laceration of the skin over or near the fracture site, what type of fracture is it?

Answer 2

Open fracture

Question 3

Fracture perpendicular to the shaft of bone

Answer 3

Transverse

Question 4

Fracture line at an angle to the shaft

Answer 4

Oblique

Question 5

A fracture with more than two fragments

Answer 5

Comminuted

Question 6

Fracture line crosses the articular cartilage into the joint

Answer 6

Intra-articular

Question 7

One cortex of the bone buckles without breaking, usually distal radius of ulna, often in kids

Answer 7

Torus

Question 8

Fracture fragments are out of their usual alignment

Answer 8

Displaced

Question 9

A gap exists between the proximal and distal segments of the fracture

Answer 9

Distracted

Question 10

Angular deformity of a bone without a complete fracture

Answer 10

Greenstick

Question 11

The day after a new femur fracture, a patient is found to be confused and short of breath. On examination, the patient is dyspneic and has a scattered pin-point rash. What is the most likely diagnosis?

Answer 11

Fat embolism syndrome

Question 12

How are growth plate fractures in children classified?

Answer 12

• Salter-Harris fractures.
  
  • I: physis (growth plate)
  • II: metaphysis and physis
  • III: epiphysis and physis
  • IV: all three
  • V: crush injury to physis

Question 13

What Salter-Harris fractures require surgical repair to prevent future complications?

Answer 13

Types III, IV, and V

Question 14

What are the risk factors for fracture nonunion?

Answer 14

• Smoking
• infection, malnutrition
• NSAID overuse
• poor immobilization
• fracture location with poor blood supply

Question 15

What are the four Rs for treatment of fractures?

Answer 15

• Recognition
• Reduction
• Retention of reduction with a splint, cast, or fixation
• Rehabilitation

Question 16

What is the risk of casting a patient directly following an acute fracture?

Answer 16

Affected site can swell, making the cast too tight and risking a vascular or nerve injury or compartment syndrome

Question 17

What are considerations in the radiographic evaluation of a long bone fracture?

Answer 17

• Image joints above and below fracture site to look for dislocation
• obtain images in at least two planes at 90° to each other (AP and lateral)

Question 18

What additional images should you consider in children with an extremity fracture?

Answer 18

Views of asymptomatic limb, since open physes can make it difficult to identify fracture

Question 19

What orthopedic injuries require immediate consultation?

Answer 19

• Fracture with vascular injury and pelvic ring injuries

Question 20

What injuries require orthopedic care within 6 hours of the initial injury?

Answer 20

• Hip dislocation
• open fracture
• penetrating joint injury
• compartment syndromes

Question 21

What is the name for a bony projection without a secondary ossification center, where a muscle attaches?

Answer 21

Apophysis

Question 22

What is the most commonly fractured long bone in children?

Answer 22

Clavicle

Question 23

What is the major risk for an infant with a clavicle fracture at birth?

Answer 23

Brachial nerve palsy

Question 24

What type of fracture is most typically associated with the following scenarios?

A child falls on an outstretched hand

Answer 24

• Distal radius fracture
• scaphoid fracture in older children and adolescents

Question 25

Type of fracture

A 3-year-old girl refused to bend her elbow after being lifted by her hand

Answer 25

Radial head subluxation (Nursemaid elbow)

Question 26

Type of fracture

A 24-year-old male punches a wall and fractures his right fifth metacarpal neck

Answer 26

Boxer fracture

Question 27

A female raises her arms in self-defense, and her left arm absorbs the blow of a blunt object

Answer 27

Ulnar shaft fracture (Nightstick fracture)

Question 28

Name the risks and/or complications associated with the Supracondylar fracture of the humerus

Answer 28

• Volkmann ischemic contracture
  
  • brachial artery at risk

Question 29

Risks/complications associated with mid-shaft humerus fracture

Answer 29

• Risk of injury to radial nerve
  
  • —> resulting wrist drop and loss of thumb abduction

Question 30

Risks/complications associated with Proximal third scaphoid fracture in hand

Answer 30

Avascular necrosis (AVN)/nonunion due to disruption of blood supply

Question 31

Risks/complications associates with a Boxer’s fracture with skin laceration from punching someone in the jaw

Answer 31

• Infection with oral pathogens, such as Eikenella.
• Treat with surgical irrigation, debridement, and IV antibiotics.

Question 32

Risks/complications associated with a nonpathologic fracture of proximal humerus

Answer 32

• Frozen shoulder (early ROM exercises when pain improves, out of sling early)

Question 33

Risks/complications associate with Fifth metatarsal stress fracture

Answer 33

Nonunion of bone fragments

Question 34

Risks/complications associated with Tibial fracture

Answer 34

Acute compartment syndrome