Section 19 - injuries to bones, joints, soft tissue

Question 1

What radiographs are required for diagnosis of an injury to a long bone?

Answer 1

• Joint proximal and distal xray

Question 2

Common diagnoses missed by xray?

Answer 2

• Scaphoid, radial head, metatarsal shaft fx

Question 3

Salter-harris type 1?

Answer 3

• Through the epiphysis

Question 4

Salter-harris type 2?

Answer 4

• Above the physis (metaphysis)

Question 5

Salter-harris type 3?

Answer 5

• Below the physis (epiphysis)

Question 6

Salter-harris type 4?

Answer 6

• Through the epi/meta/physis

Question 7

Salter-harris type 5?

Answer 7

• Compression of the physis

Question 8

5 signs of compartment syndrome?

Answer 8

• Pain, pallor, paresthesias, pulselessness, paralysis

Question 9

Tx of fracture/sprain/strain? Open fx?

Answer 9

• Control swelling, pain control, remove objects such as rings/watches, reduction of fx/dislocation
• Open fx need abx, irrigation, debridement

Question 10

Test for median nerve motor function on hand?

Answer 10

• Flex thumb against resistance

Question 11

Test for ulnar nerve motor function on hand?

Answer 11

• Spread fingers against resistance

Question 12

Test for radial nerve motor function on hand?

Answer 12

• Maintaining extension of wrist and fingers against resistance

Question 13

What is the best way to test tendon function?

Answer 13

• Test tendon function against resistance, 90% can be torn and still move without resistance

Question 14

What is mallet finger?

Answer 14

• Rupture of extensor tendon at DIP, flexed at 40 degrees, splint in hyperextension

Question 15

What is boutonniere deformity?

Answer 15

• Flexor at PIP and hyperextensor of DIP joint, splint PIP in extension

Question 16

Tx of DIP and PIP joint dislocations?

Answer 16

• Digital block, reduce by distraction, hyperextension, then reposition, splint in full extension
• Be concerned about irreducible joint

Question 17

Tx of MCP joint dislocations?

Answer 17

• Most likely need surgery, attempt closed reduction and splint with MCP joint flexed 70-90 degrees

Question 18

Thumb IP joint dislocations tx?

Answer 18

• Closed reduction, thumb in spica splint

Question 19

Tx of thumb MCP dislocations?

Answer 19

• Reduce by flexing and abducting metacarpal with pressure, place in thumb spica

Question 20

Tx of thumb MCP ulnar collateral ligament rupture?

Answer 20

• Place in thumb spica splint (gamekeeper or skier thumb)

Question 21

Tx of MC fractures of fourth or fifth? Tx of MC fractures of second or third? Tx of MC fractures of thumb?

Answer 21

• Ulnar gutter splint, radial gutter splint, thumb spica splint

Question 22

Which wrist bones can cause avascular necrosis of bone?

Answer 22

• Scaphoid, lunate, capitate

Question 23

What is a colles fracture?

Answer 23

• Distal radius displaced proximally and dorsally, ulnar styloid may be fractured

Question 24

What is a smith fracture?

Answer 24

• Distal radius displaced proximally and volarly

Question 25

What is a barton fracture?

Answer 25

• Volar and proximal displacement of radial articular surface, volar displacement of carpus, radial styloid may be fractured

Question 26

Difference between proximal long head biceps tendon rupture vs distal tendon rupture?

Answer 26

• Elbow flexion maintained with proximal, weak with distal tendon rupture

Question 27

How do you test for distal biceps tendon rupture?

Answer 27

• Examiner squeezes muscle belly of bicep with elbow flexed and forearm resting on patient’s lap

Question 28

Tx of biceps/triceps tendon ruptures?

Answer 28

• Sling, ice, analgesics and referral to ortho surgeon for definitive management, repair in young active patients

Question 29

Majority of elbow dislocations?

Answer 29

• Posterolateral

Question 30

What should you be concerned about in elbow dislocation?

Answer 30

• Neurovasc compromise: absence of radial pulse before reduction, systemic injuries suggestive of arterial injury

Question 31

Which elbow fracture is concerning for NV compromise? What is one feared complication?

Answer 31

• Supracondylar fracture, Volkmann ischemic contracture: refusal to open hand, pain with passive extension of fingers, forearm tenderness, also all nerve problems

Question 32

Tx of elbow fx nondisplaced?

Answer 32

• Sling immobilization and ortho referral

Question 33

Tx of elbow fx displaced, open, or NV compromise?

Answer 33

• Admit with immediate ortho

Question 34

What is monteggia fx?

Answer 34

• Proximal third of ulna with radial head dislocation

Question 35

What is galeazzi fx?

Answer 35

• Fracture of distal radius with associated distal radioulnar dislocation

Question 36

Tx of forearm fx?

Answer 36

• Nondisplaced with long-arm splint and referral

- Displaced need ortho consult

Question 37

Feared complications of sternoclavicular sprains and dislocations?

Answer 37

• Hoarseness, dysphagia, dyspnea, upper extremity paresthesias or weakness = PTX, great vessel problem, trachea problem, esophagus problem

Question 38

Tx of sternoclavicular sprains/disloactions?

Answer 38

• Ice, analgesics, sling immobilization, if posterior call ortho for ORIF

Question 39

What should one look for with scapula fx?

Answer 39

• Associated intrathoracic injuries

Question 40

Views for glenohumeral joint dislocation?

Answer 40

• Ap and scapular Y view

Question 41

What nerve is injured with proximal humeral fractures?

Answer 41

• Axillary nerve and artery

Question 42

What nerve is injured with humeral shaft fractures?

Answer 42

• Radial nerve

Question 43

Tx of pelvic fx?

Answer 43

• Bind, look for other source of bleeding, send to angio with embolization and external fixation, ORIF