TRAUMATOLOGY Flashcards
An open fracture can be treated in the same way as a closed fracture if
A) it is a type 1 open fracture
B) has only minimal lateral dislocation
C) it is a type 2 open fracture
D) in any type of open fracture, after proper treatment of the wound
A) it is a type 1 open fracture
Only type 1 open fractures can be treated in the same manner as closed fractures because type 1 open fractures are a result of low energy trauma, the fractured bone ruptures the skin and soft tissue from inside out, therefor the incidence of bacterial infection is low. This is why this type of fracture is considered and treated in a similar way as closed fractures.
The following is true concerning compartment syndrome:
A) early absence of peripheral pulse
B) early absence of capillary refill
C) no pain
D) it does not occur if the injury is open
B) early absence of capillary refill
Immense pain and the early absence of capillary refill are characteristic of compartment syndrome. It can occur even in open injuries. Pulselessness is a late symptom.
What type of x-ray is needed to differentiate between the types of acromioclavicular joint dislocations?
A) clavicle x-ray
B) lateral scapula shoulder Y view
C) comparative weight bearing stress x-ray
D) shoulder x-ray
C) comparative weight bearing stress x-ray
Only the comparative weight bearing stress x-ray is the appropriate examination: the patient holds weights in both arms. No changes will be seen on the uninjured-intact side, whereas on the injured side, the AC joint dislocation will be obvious.
Which is the most common nerve injury resulting from shoulder dislocations? A) Axillary nerve B) Brachial plexus C) Radial nerve D) Ulnar nerve
A) Axillary nerve
The most commonly injured nerve is the axillary (circumflex) nerve, since it travels around the surgical neck of the humerus and is stretched during the dislocation. The brachial plexus is less frequently injured, when the dislocated humeral head directly presses it.
Which classification system is best for prognosis of proximal humerus fractures?
A) The Neer classification based on the number of fractured fragments
B) Garden classification
C) Böhler classification
D) Pauwels classification
A) The Neer classification based on the number of fractured fragments
Which is the most frequently missed shoulder dislocation?
A) Luxatio erecta – inferior dislocation
B) Posterior dislocation
C) Axillary dislocation
D) Anterior dislocation
B) Posterior dislocation
We must think of this if the contour of the humerus head and glenoid contour overlap each other.
In a Monteggia fracture, where is the location of the radius head dislocation?
A) In the proximal radioulnar joint
B) In the distal radioulnar joint
C) There is no dislocation, it follows the fracture line
D) The elbow joint is dislocated
A) In the proximal radioulnar joint
In an anterior cruciate ligament rupture, the anterior drawer sign, the Lachman test and the pivot shift test are all positive.
A) Only the first two tests are positive
B) All three tests are positive
C) Only the last two tests are positive
D) Only the first and last tests are positive
B) All three tests are positive
Locking of the knee joint and recurrent knee joint swelling with longer symptom-free periods are characteristics of which injury? A) Meniscal tear B) Cruciate ligament tear C) Arthritis D) Baker-cyst
A) Meniscal tear
Characteristics of a meniscal tear include locking of the knee joint, recurrent knee joint swelling and longer symptom-free periods. Hemarthros is typical in the acute phase of a cruciate ligament injury, while instability is the main symptom in the chronic phase. Baker cyst inhibits full knee flexion, while pain to weight bearing is the leading symptom of knee arthritis.
Surgical fixation is necessary in a dislocated (distracted) patella fracture where there is incongruence of the articular surface.
A) It always requires surgical treatment
B) It does not always require surgical treatment, only when there is discontinuity of the extensor apparatus
C) Just as good results can be achieved with conservative treatment
D) Surgical treatment is only necessary if there is an osteochondral fracture
A) It always requires surgical treatment
In patella fractures, surgical fixation is indicated when there is dislocation (distraction) as well as when there is articular surface incongruence. Dislocation (distraction) leads to insufficient function, due to the discontinuity of the extensor apparatus, while incongruence of the articular surface of the patella leads to early posttraumatic arthritis.
What is the goal in the treatment of distal radius fractures?
1) To retain the original length of the bone
2) To restore the Böhler joint angles
3) To restore congruency of the joint
4) To inhibit redislocation
A) all of the answers are correct
B) only the 1st and 2nd answers are correct
C) only the 1st, 3rd and 4th answers are correct
D) only the 1st and 4th answers are correct
A) all of the answers are correct
Which of the following have a high risk in a traumatic hip joint dislocation?
1) Femoral head necrosis
2) Extensive cartilage damage/early arthritis
3) Sciatic (ischiadic) nerve injury
4) Infection
A) only the 1st and 2nd answers are correct
B) only the 1st, 2nd and 3rd answers are correct
C) all of the answers are correct
D) only the 4th answer is correct
B) only the 1st, 2nd and 3rd answers are correct
In a medial femoral neck fracture, the affected lower limb is shortened, in external rotation, and the patient cannot actively elevate his leg.
1) This is true for all types of femoral neck fractures
2) This is not true for laterobasal femoral neck fractures
3) This is not true for valgus type impacted femoral neck fractures
4) This is not true for non-dislocated Garden type II femoral neck fractures
A) only the 1st answer is correct
B) only the 2nd answer is correct
C) only the 3rd answer is correct
D) only the 3rd and 4th answers are correct
D) only the 3rd and 4th answers are correct
In Garden type III and IV medial femoral neck fractures, the affected lower limb is shortened, in external rotation, and the patient cannot actively elevate his leg. In impacted, non-dislocated femoral neck fractures (Garden type II) and in valgus impacted fractures (Garden type I), the patient can frequently even elevate the leg.
Which of the following are correct regarding a degloving injury?
1) The skin and its underlying tissues are torn off the fascia
2) It can be an open or closed injury
3) It can be associated with significant blood loss
4) Skin necrosis is common
A) only the 1st answer is correct
B) only the 1st and 2nd answers are correct
C) only the 1st, 2nd and 3rd answers are correct
D) only the 1st, 2nd, 3rd and 4th answers are correct
D) only the 1st, 2nd, 3rd and 4th answers are correct
In a degloving injury, the skin and its underlying tissues are torn off the fascia. Significant amount of bleeding can develop into the recessed area. The blood supply to the skin above the injury is severed, therefore skin necrosis is common. The injury can be open or closed.
What can be the cause of delayed bone healing and nonunion?
1) Disturbed blood supply of the fractured bone
2) Soft tissue damage
3) Soft tissue interposition
4) Too much distance between the fractured bony ends
A) only the 1st answer is correct
B) only the 1st and 2nd answers are correct
C) only the 1st, 2nd and 3rd answers are correct
D) all of the answers are correct
D) all of the answers are correct
The primary cause of delayed bone healing and nonunion is disturbed blood supply to the fractured bony ends. This can be due to damage to the soft tissue, soft tissue interposition between the fractured ends and too much traction causing too much distance between fractured ends of the bone.
Which of the following are associated injuries of shoulder dislocations, which lead to recurrent shoulder dislocation?
1) Bankart-lesion
2) Hill–Sachs-lesion
3) Rotator cuff injury
4) Axillary nerve paresis
A) only the 1st answer is correct
B) only the 2nd answer is correct
C) only the 1st, 2nd, 3rd and 4th answers are correct
D) only the 1st and 2nd answers are correct
D) only the 1st and 2nd answers are correct
Recurrent shoulder dislocations can occur due to all associated injuries, which lead to the instability of the joint. In Bankart lesions, the capsule and part of the labrum are torn off the glenoid. In a Hill-Sachs lesion, the depressed fracture of the humerus head leads to incongruence of the joint, which may cause luxation when the rotational position of the depressed humeral head allows it to dislocate from the glenoid cavity.
Which of the following pose the greatest risk in pediatric supracondylar humerus fractures?
1) Misdiagnosis of brachial artery injury
2) Volkmann‘s ischemic contracture
3) Nonunion
4) Median nerve injury
A) all of the answers are correct
B) only the 1st and 2nd answers are correct
C) only the 1st, 2nd and 3rd answers are correct
D) only the 4th answer is correct
B) only the 1st and 2nd answers are correct
The greatest risk of pediatric supracondylar humerus fractures are missed diagnosis of brachial artery injuries, which leads to Volkmann’s ischemic contracture.
What do we need to take into consideration in tibia pilon (plafond) fractures?
1) The mosaic type fracture of the cartilage of the tibiotalar joint
2) Severe soft tissue damage
3) Delayed bone union
4) Posttraumatic arthritis
A) only the 1st, 2nd, 3rd and 4th answers are correct
B) only the 2nd and 3rd answers are correct
C) only the 3rd answer is correct
D) only the 3rd and 4th answers are correct
A) only the 1st, 2nd, 3rd and 4th answers are correct
Severe damage to the articular surfaces of the talotibial joint are always present in tibia pilon (plafond) fractures, and this always leads to the development of posttraumatic arthritis in the ankle joint. Severe soft tissue damage is also always present. Due to these factors as well as due to the comminuted fracture and bone loss, we can count on delayed bone union.
After reduction of an elbow dislocation, if the joint is stable, we should not immobilize the joint for over 1 week because the risk of extension deficit increases linearly with the time period of immobilization.
A) The first statement is true
B) The first statement is false
C) Both statements are true and there is a logical correlation between the two
D) Both statements are false
C) Both statements are true and there is a logical correlation between the two
The elbow joint is rather sensitive to all kinds of trauma and immobilization. If the joint is stable after reduction, the shortest time period of immobilization is practical. The hindrance of early mobilization is due to pain. After reduction of the elbow joint, we apply a cast splint, but after a few days, the arm should be removed from the splint for physiotherapy and then placed back into the splint. The time of immobilization should still not exceed one week.
Isolated radius head subluxation (nursemaid’s elbow) in children is caused by the sudden pulling of the arm, therefore the child is unable to pronate the forearm.
A) The first statement is true
B) The first statement is false
C) Both statements are true and there is a logical correlation between the two
D) Both statements are false
C) Both statements are true and there is a logical correlation between the two
Radial head subluxation in children is caused by the sudden pulling of the child’s arm, after which the elbow’s movements are impaired. Not only is flexion and extension reduced, but also pronation of the forearm. This is also called pronation dolorosa infantum, or pulled elbow or nursemaid’s elbow for these reasons.
The most frequent complication of femoral neck fractures - femoral head necrosis – only occurs in Garden type 3 and 4 fractures because the arterial blood vessels are injured only in these types of fractures.
A) The first statement is true
B) The first statement is false
C) Both statements are true and there is a logical correlation between the two
D) Both statements are false
D) Both statements are false
Arterial blood vessel injury leading to femoral head necrosis can occur in all types of femoral neck fractures. Undoubtedly, it is more frequent in Garden type 3 and 4 fractures.
The prognosis of femoral neck fractures is the same in the elderly and young patients because the mechanism of injury is the same in both groups.
A) The first statement is true
B) The first statement is false
C) Both statements are true and there is a logical correlation between the two
D) Both statements are false
D) Both statements are false
The prognosis of femoral neck fractures in the elderly and young patients is not the same; in young patients, the mechanism of injury is high energy trauma, having a much worse prognosis.