Orthopedic Injuries

Question 1

What dislocations should you not consider doing field reduction?

Answer 1

Ankle, Elbow, Midfoot, AC, Wrist, Hip, Spine.

These injuries likely will cause more issues OR are harder to reduce in the field.

Question 2

What dislocations are considered Emergent?

Answer 2

Knee and Hip.
Posterior knee dislocation has a 15% chance of arterial injury to the popliteal artery.
Hip dislocation can disrupt supply of the femoral head/neck.

Question 3

Are dislocated joints easier or harder to reduce over time?

Answer 3

Harder; the muscles contract and the capsule and cartilage are damaged, causing more difficulty in reduction.

Question 4

What should be checked before and after every manipulation of a dislocation, fracture, or injury?

Answer 4

NV status.

Question 5

What are the 6 Ps of Compartment syndrome?

Answer 5

Pain
Paresthesias
Paralysis
Pallor
Poikilothermia (coolness)
Pulselessness.

Question 6

The shoulder is most often dislocated in which direction? What causes dislocations in the other direction?

Answer 6

Anterior is most common (>80%)
Posterior is caused by seizures most often.
Anterior dislocation will have an internally rotated arm with a prominent acromion, a flattened shoulder, and the humeral head present in the superior-lateral pectoralis area.
Anterior is most common (>80%)
Posterior is caused by seizures most often.

Question 7

A patient is rock climbing and has a fall, but attempts to catch himself on 1 finger. He yells out in pain. When he comes down, he is unable to make a full fist. What is the injury, and what should you do?

Answer 7

This is a likely flexor tendon rupture. This requires specialized surgery ASAP, so it is an URGENT casevac.
If there is a bowing of the flexor tendons noted in the medial finger, it could be a flexor pulley rupture, which would present more with a loss of grip strength. This also needs an urgent casevac.

Question 8

A patient falls on his outstretched hand and presents with pain in his wrist. He has tenderness in the anatomic snuff box and posterior radial (lateral) wrist. What is the most likely bone injury and what should be done if the patient has a negative initial Xray?

Answer 8

This is a likely Scaphoid fracture. The Xray is often negative and 2 weeks of immobilization with a thumb spica splint should occur followed by a repeat Xray.

Question 9

If a patient presents with hip pain, how can you distinguish between femur/bone pain and bursitis?

Answer 9

Lateral hip pain is usually bursitis over the greater trochanter. Groin pain is often femoral neck pain (can be some other things), but stress fracture should be ruled out.

Question 10

What areas of the ankle should be evaluated to determine if a patient has a fracture after a rolled ankle?

Answer 10

Medial Malleolus and 6cm up
Lateral Malleolus and 6cm up
5th metatarsal base
Ability to bear weight immediately for 4 steps
**Pain in the navicular - officially part of the foot rules, but LT Roberts continues to stress this one.