Orthopedics

Question 1

When someone is injured, what are the four things you do when you talk to them and do the examination?

Answer 1

• anamnesis
• inspection
• palpation
• PMS

Question 2

Anamnesis

Answer 2

• this should be done first unless there is an immediate issue like gushing blood
• mechanism of trauma (what happened and was there outside forces ie. a soccer ball)
• was it high or low energy
• repositioning? (what has been done –> did you come on an ambulance and did they do anything)
• previous trauma
• predisposing factors

Question 3

what is a high vs. low energy injury?

Answer 3

• this is how likely the internal organs have been messed up
• driving at 60 MPH is on the verge of high energy (motorcycle is less because more exposed and a bike is 25 MPH)

Question 4

inspection

Answer 4

• edema
• hematoma/discoloration
• malalignment
• skin threatened
• wound (need to check for infection because once it enters bone it can become severe)

Question 5

palpation

Answer 5

direct or indirect (good to test indirect pain in children because they are not the best at dealing with pain–> might need to distract them)

Question 6

PMS

Answer 6

• pulse, motor function, sensation (nerve innervation)

- checking to see if there is any loss of connection, via blood or nerves

Question 7

clavicle fracture

Answer 7

• very common in children and youth
• 80% of injuries are in the intermediate part of the bone (thin part)
• 6 week healing time

Question 8

treatment for intermediate segment issues

Answer 8

• collar n cuff (2 weeks or until pain free)
• surgery (this is considered if significant shortening of clavicle)
• rehabilitation (shoulder movement as soon as possible so that things do not become stiff)

Question 9

surgery is done to all collar bone fractures if:

Answer 9

• risk of perforation of the skin
• risk of necrosis of the skin
• damage to vessels or nerves

Question 10

supination trauma

Answer 10

this is rolling your ankle and putting too much pressure on the outside of your ankle

Question 11

Ottawa Ankle Rules

Answer 11

this is used to see if an x-ray needs to be taken
-direct pain on palpation
-ability to carry weight both right after trauma and during examination
(if either is positive –> take x-ray)

Question 12

what happens if there is pain but negative findings to other tests?

Answer 12

this is most likely a sprain –> RICE-M

Question 13

RICE-M

Answer 13

rest
ice
compression
elevation
mobilization

Question 14

how long do you rest for for RICEM

Answer 14

24-48 hours

Question 15

how long do you ice for for RICEM

Answer 15

-apply ice wrapped in towel for 20 minutes maximum, repeat 3-4 times

Question 16

compression for RICEM

Answer 16

• this is used to reduce swelling and therefore loss of function and pain
• elastic bandage is used

Question 17

when is mobilization done in RICEM

Answer 17

this is after the resting period and allows for a faster recovery

Question 18

what is the thompsons test?

Answer 18

this is a test done on the achilles tendon, it is also known as the squeeze test

• when you squeeze it, it will move (plantar flexion)
• if there is disruption to the aches tendon, no movement

Question 19

what are signs of the achilles tendon being ruptured?

Answer 19

• unable to stand on toes

- there will be a positive thompsons test

Question 20

planters muscle

Answer 20

• small variable muscle
• inserts on the calcaneus
• involved in the plantar flexion

Question 21

when should we choose conservative over surgical treatment for an achilles tendon rupture?

Answer 21

best to be conservative if there is poor circulation, diabetes, a smoker, or have used steroids)

Question 22

conservative treatment for an achilles rupture

Answer 22

• there are possible healing issues with this and a greater risk of rerupture
• will have a longer absence from workforce
• will have an equal rerupture risk as surgery if early mobilization and weight load increases and early rehabilitation

Question 23

what is high risk factors for neck injury?

Answer 23

• 65 years or older

- dangerous mechanism (falling from more than 1 meter, car vs. bike collision, high energy trauma, car rolling over)

Question 24

what are low risk factors for neck injury

Answer 24

• simple rear ending
• sitting in the ER waiting room
• able to walk around
• delayed onset of pain

Question 25

what does it mean if you have high risk factors for a neck injury?

Answer 25

cervical CT is done

Question 26

why is it important to give patients information on a whiplash injury?

Answer 26

Because if the patient does not get back to their normal activities then it can lead to chronic pain (explain that it is important to get back to normal activities ASAP and that pain med might be needed for a few weeks and they might have acute systems)

Question 27

What are some acute symptoms of whiplash?

Answer 27

• neck pains
• stiffness in the cervical area
• headaches
• dizziness

Question 28

hip fracture/ proximal femer fracture

Answer 28

• common among older people with osteroporosis
• commonly fatal( because they are bed ridden and become weak and lose sense of balance and then fall and break something else)