PaSSMed: trauma and orthopaedics

Question 1

A 38-year-old man is playing football when he slips over during a tackle. His knee is painful immediately following the fall. Several hours later he notices that the knee has become swollen. Following a course of non steroidal anti inflammatory drugs and rest the situation improves. However, complains of recurrent pain. On assessment in clinic you notice that it is impossible to fully extend the knee, although the patient is able to do so when asked.

Answer 1

Torn meniscus51%

Twisting sporting injuries followed by delayed onset of knee swelling and locking are strongly suggestive of a menisceal tear. Arthroscopic menisectomy is the usual treatment.

Question 2

A 34-year-old woman is a passenger in a car during an accident. Her knee hits the dashboard. On examination the tibia looks posterior compared to the non injured knee.

Answer 2

Posterior cruciate ligament rupture73%

In ruptured posterior cruciate ligament the tibia lies back on the femur and can be drawn forward during a paradoxical draw test.

Question 3

A 28-year-old professional footballer is admitted to the emergency department. During a tackle he is twisted with his knee flexed. He hears a loud crack and his knee rapidly becomes swollen.

Answer 3

Anterior cruciate ligament rupture57%

This is common in footballers as the football boot studs stick to the ground and high twisting force is applied to a flexed knee. Rapid joint swelling also supports the diagnosis.

Question 4

A 14-year-old patient is brought to the emergency department following an accident playing football. He landed awkwardly on his arm and was found to have a fracture. This was reduced but the patient is still experiencing extreme pain, particularly on passive stretching. His arm appears swollen and he is complaining of tingling in his hand and forearm.

Which fracture is most commonly associated with the condition he is experiencing?

Answer 4

supracondylar fracture

Compartment syndrome is most commonly associated with supracondylar and tibial shaft fractures

Question 5

A 32-year-old man presents with a painful swelling over the volar aspect of his hand after receiving a hard blow to his palm. On examination, he experiences pain on moving the wrist and on longitudinal compression of the thumb.

Answer 5

Scaphoid fracture70%

Scaphoid fractures usually occur as a result of direct hard blow to the palm or following a fall on the out-stretched hand. The main physical signs are swelling and tenderness in the anatomical snuff box, and pain on wrist movements and on longitudinal compression of the thumb

Question 6

A 26-year-old man presents to the emergency department with a swelling over his left elbow after a fall on an outstretched hand. On examination, he has tenderness over the proximal part of his forearm, and has severely restricted supination and pronation movements.

Answer 6

Fracture of the radial head34%

Fracture of the radial head is common in young adults. It is usually caused by a fall on the outstretched hand. On examination, there is marked local tenderness over the head of the radius, impaired movements at the elbow, and a sharp pain at the lateral side of the elbow at the extremes of rotation (pronation and supination).