Orthopedic Procedures

Question 1

What should be done prior to obtaining an XR for an injury?

Answer 1

Complete history and physical. Not all injuries need imaging

Question 2

Sprain vs. Strain

Answer 2

Sprains= Ligamentous stretch that causes tearing. Can result in bruising and patients hear a characteristic “pop”

Strains= Muscle/soft tissue injury, usually does not have any observable signs. Patients report a “grabbing sensation”

Question 3

Steps to PE for an MSK injury

Answer 3

Inspection
Palpation- use back of hand for temperature, check OxI’s of muscles, fractures tend to have point tenderness
ROM- watch for signs of pain
Neuromuscular exam

Always compare bilaterally

Question 4

Ottawa Ankle Rules for an XR

Answer 4

1. Bone tenderness along distal tibia OR medial malleolus
2. Bone tenderness along posterior fibular OR Lateral Malleolus
3. Inability to bear weight for 4 steps after injury and in ED

Question 5

Ottawa “foot” XR rules

Answer 5

1. Tenderness at 5th metatarsal base
2. Navicular tenderness
3. Inability to walk 4 steps

Question 6

Treatment for sprains

Answer 6

RICE- Rest, Ice (48-72h), Compression, Elevation

Referral to ortho

Question 7

What is buddy taping?

Answer 7

Used for finger/toe injuries to stabilize non displaced fractures (hairline fx)
recommended for 2-3w

Question 8

Types of fractures (SAC COST)

Answer 8

Simple- 2 pieces
Comminuted- crushed into pebbles
Avulsion- fx at site of ligament origin/insertion 
Compound- opens the skin 
Spiral- twisting caused by torque
Oblique- caused by long axis force 
Transverse- perpendicular blow to bone

“SAC COST”

Question 9

What type of splint could be used for a distal radial & Ulnar fracture?

Answer 9

Sugar Tong

Question 10

What type of cast can be used for a navicular fx, Radius/Ulna shaft fx, or a colles fx?

Answer 10

Long-Arm Cast

Question 11

What is an ulnar gutter cast used for?

Answer 11

Fx of neck, shaft, & base of 4/5 metacarpals

Question 12

What infection is a common cause of septic arthritis?

Answer 12

Neisseria Gonorrhea

Question 13

Indications for Joint Arthrocentesis

Answer 13

1. Relief of pain from effusion/hemarthroses
2. Steroid Administration
3. Intraarticular fibrosis
4. Establish diagnosis of infection

Question 14

Contraindications for Arthrocentesis

Answer 14

1. Don’t pass needle through infected skin, subQ tissue
2. Caution in anticoaged patients
3. Bacteremia is relative contraindication

Question 15

Common causes of joint pain

Answer 15

Gout
Pseudogout
Infections
OA 
RA

Question 16

Landmarks for shoulder arthrocentesis

Answer 16

Needle goes inferolateral to coracoid process and directed posteriorly toward joint space

Question 17

Landmarks for knee arthrocentesis

Answer 17

Needle enters 1cm medial or lateral to superior third of patella

Question 18

A patient has elevated uric acid levels. is this indicative of gout?

Answer 18

NO! Serum levels serve no purpose in diagnosis of gouty arthritis