Orthopedic Emergencies

Question 1

focused assessment for trauma with sonography. finds blood around heart and abdominl organs

Answer 1

FAST scan

Question 2

Decreases pelvic volume promoting tamponade. Prevents shifting of the fractures which causes more bleeding.

Answer 2

stabilize pelvis with external fixator

Question 3

muscle breakdown products which can cause renal failure

Answer 3

rhabdomyolysis

Question 4

At which joints do vessels and nerves go through tight spaces?

Answer 4

elbow and knee

Question 5

Describe a class 1 open fracture

Answer 5

puncture wound, minimal signs of contamination

Question 6

Describe a class 2 open fracture

Answer 6

open fracture with minimal soft tissue damage and contamination

Question 7

Describe a class 3 open fracture

Answer 7

grossly contaminate wound with little skin coverage

Question 8

When should you not close a bite wound?

Answer 8

if on hands and feet, crush injuries, deep punctures

Question 9

When should you close a bite wound?

Answer 9

if on face, not infected, less than 24 hours

Question 10

What abx should you use as prophylaxis for a cat bite, deep puncture, crush injury, or hand wound?

Answer 10

Amoxicillin clavulanate

Question 11

What pathogen do you need to worry about with nail puncture wounds and can be treated with cipro?

Answer 11

pseudomonas

Question 12

What is used to fill the defect left by tumor resection and operative fixation of an impending fracture from a tumor?

Answer 12

methylmethacrylate

Question 13

Elevated interstitial pressure prevents muscle capillary flow. Ischemia in the compartment causes severe pain

Answer 13

acute compartment syndrome

Question 14

Where does acute compartment syndrome occur most often?

Answer 14

in lower leg and forearm Fx’s

Question 15

What is the most sensitive test for acute compartment syndrome?

Answer 15

pain with passive stretch of the muscles

Question 16

What should you NOT do when treating compartment syndrome?

Answer 16

elevate the part

Question 17

What is the definitive treatment of acute compartment syndrome?

Answer 17

fasciotomy

Question 18

Seen in pelvic and long bone Fx’s, closed more than open. Clinical syndrome: pulmonary distress, CNS changes, petechiae. 72 hrs post injury

Answer 18

fat embolism syndrome

Question 19

What is the prophylaxis for fat embolism syndrome that should be considered in closed pelvic and long bone Fx’s?

Answer 19

Low dose steroids

Question 20

6 hours after ORIF for a supracondylar elbow fracture your patient complains of increasing arm pain. He has marked pain with passive dorsiflexion of his fingers. What do you do next?

Answer 20

measure compartment pressures

Question 21

3 days after a femoral fracture your patient becomes confused and
short of breath. How do you treat him/her?

Answer 21

respiratory support

Question 22

6 days after an open ankle fracture treated with surgery your patient complains of increasing wound pain and feels sick. What do you do?

Answer 22

wound inspection –antibiotics

Question 23

10 days after rodding a femoral fracture you patient complains of
pleuritic chest pain and shortness of breath. How do you handle this?

Answer 23

anticoagulants and respiratory support

Question 24

What is the most important treatment in open fracture?

Answer 24

initiation of abx

Question 25

What it the protocol for someone who has an open fracture and isn’t up to date on their tetanus?

Answer 25

give tetanus antibody as well as antigen in opposite areas of the body

Question 26

What should every patient who has an injury related to farming be given for abx?

Answer 26

penicillin G

Question 27

What is the most sensitive clinical sign for compartment syndrome?

Answer 27

pain out of proportion to the injury

Question 28

What are the 5 P’s of compartment syndrome?

Answer 28

Pain, Pulse, Pallor, Paralysis, Paresthesia

Question 29

What value of a hand held monometer is too high to allow for capillary perfusion (ie compartment syndrome)?

Answer 29

value is within 30mmHg of the patients diastolic pressure

Question 30

What is the difference between Colles and Smith fractures?

Answer 30

Colles is displaced dorsally whereas Smith is displaced volarly

Question 31

fracture of the radius with dislocation of the distal radioulnar joint

Answer 31

Galeazzi fracture

Question 32

a fracture of the proximal third of the ulna with dislocation of the head of the radius

Answer 32

Monteggia fracture

Question 33

a fracture of the distal third of the humerus resulting in entrapment of the radial nerve.

Answer 33

Holstein-Lewis fracture

Question 34

a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane

Answer 34

Maisonneuve fracture