Trauma/Extremity Injury

Question 1

Isolated trauma to an extremity with associated vascular injury has ____% rate of mortality or limb loss

Answer 1

10%

Question 2

What is more common, injuries involving lower extremity or upper extremity?

Answer 2

Lower extremity is more common

Question 3

What are the 2 most commonly injured blood vessels?

Answer 3

Femoral and popliteal

Question 4

Nerves, bone, soft tissue, vascular supply

Answer 4

Evaluate extent of injury

Question 5

Most common causes of penetrating trauma?

Answer 5

Gunshot wounds and stab wounds

Question 6

Larger extent of tissue damage, wider range of patterns of injury

Answer 6

Gunshot wounds

Question 7

More straightforward, predictable pattern of injury

Answer 7

Stab wounds

Question 8

List 3 signs of vascular trauma

Answer 8

• Absent or diminished distal pulses
• Obvious arterial bleeding
• Large expanding or pulsatile hematoma
• Audible bruit
• Palpable thrill
• Distal ischemia

Question 9

How do you manage definite vascular injury to extremity?

Answer 9

Vascular surgery consult

Question 10

How do you manage a lower extremity injury if you are highly suspicious of vascular injury?

Answer 10

CT angiography

Question 11

How do you manage an extremity injury if there are no signs of vascular injury?

Answer 11

ABI

Question 12

Additional testing for vascular injury

Answer 12

Creatinine before CT w/ contrast, CBC if signif. blood loss, radiography for fracture

Question 13

Complete disruption of a joint

Answer 13

Dislocation

Question 14

Partial disruption of a joint

Answer 14

Subluxation

Question 15

Tearing injury to muscle fibers

Answer 15

Strain

Question 16

Tearing injury to ligaments of a joint

Answer 16

Sprain

Question 17

Open fracture, subluxation/dislocation, neuromuscular injury, compartment syndrome are all???

Answer 17

Orthopedic emergencies

Question 18

Gross deformity is pathognomonic for??

Answer 18

Fracture

Question 19

If a shoulder is anteriorly dislocated, what nerves should you check?

Answer 19

Axillary (lateral aspect of shoulder), musculocutaneous (extensor aspect of arm)

Question 20

How do you manage a fracture in the ED?

Answer 20

Control pain and swelling, reduce fracture deformity, reduce dislocation, withhold food/drink if going to surgery

Question 21

When should you call for an ortho consult in the ED?

Answer 21

Compartment syndrome, irreducible dislocation, circulatory compromise, open fracture, surgical intervention

Question 22

When should you splint a patient?

Answer 22

Fracture or after reduction of a dislocated joint

Question 23

Used for clavicle fracture, AC separation, shoulder dislocation, humeral neck fx

Answer 23

Shoulder immobilizer

Question 24

Used for non displaced radial head fx

Answer 24

Arm sling

Question 25

Used for elbow fx and elbow dislocation

Answer 25

Long-arm gutter splint

Question 26

Used for wrist or forearm fx

Answer 26

Sugar tong splint

Question 27

Used for metacarpal or proximal phalanx fx

Answer 27

Short-arm gutter splint

Question 28

Used for scaphoid fracture, thumb metacarpal or proximal thumb phalanx fx

Answer 28

Thumb spica splint

Question 29

Used for patellar fx or subluxation, knee dislocation, tibial plateau fx, knee ligament or meniscus injury/tear

Answer 29

Knee immobilizer

Question 30

Used for ankle dislocation or fx, unstable ankle fx (eg, high, distal fibular fx or medial and/or posterior malleolar fx), widened medial mortise, metatarsal fx

Answer 30

Posterior ankle mold splint

Question 31

Used for simple ankle sprain, stable lateral malleolar fx

Answer 31

Ankle stirrup

Question 32

Used for toe fx, some metatarsal fx

Answer 32

Hard-soled shoe

Question 33

Used for some toe or foot fx where weight bearing is allowed

Answer 33

Short-leg walking boot

Question 34

When should a patient return immediately after discharge for trauma?

Answer 34

Pain is severe or increasing, numbness is new or worsening, skin discoloration distal to the splint

Question 35

If you see a scaphoid fracture on x-ray what splint do you use?

Answer 35

Thumb spica

Question 36

If you see a distal radial head fx on x-ray, what splint do you use?

Answer 36

Sugar tong

Question 37

If you see a distal 5th metacarpal fracture (boxers fracture), what splint do you use?

Answer 37

Ulnar gutter splint

Question 38

If you see a proximal 5th metatarsal fracture (jones fracture) what type of splint do you use?

Answer 38

Posterior ankle splint

Question 39

If you see an isolated lateral malleolar fracture of the fibula, what splint do you use?

Answer 39

Ankle stirrup

Question 40

If you see a trimalleolar fracture, what splint do you use? spoiler alert there’s two

Answer 40

Ankle stirrup + posterior ankle