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SD- ER pt 2 > Upper/Lower Extremity Lecture > Flashcards

Upper/Lower Extremity Lecture Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

90% of elbow dislocations are…

A

posterolateral

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2
Q

MOI usually FOOSH

pt holds elbow in 45 degrees of flexion, signifcant swelling obscures olecranon (which is displaced posteriorly)

A

Elbow dislocations

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3
Q

Ulnar Nerve
Brachial artery

..most frequently injured structres in?

A

Elbow dislocations

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4
Q

Reduction
Long arm posterior splint to immobilize elbow in slightly less than 90 degrees flexion

A

Elbow dislocation tx

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5
Q

95% of supracondylar fractures are extra articular and commonly seen in…

A

kids

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6
Q

Lateral elbow pain and tenderness

inability to fully extend elbow

(RADIAL HEAD, SUPRACONDYLAR OR OLECRANON FX?)

A

Radial head

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7
Q

Significant swelling, tenderness and limited ROM

(RADIAL HEAD, SUPRACONDYLAR OR OLECRANON FX?)

A

Inter and supracondylar fractures

(supracondylar fractures may resemble a posterior elbow dislocation)

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8
Q

Presence of abnormal fat pads on XRay
(any posterior effusion or a very prominent anterior fat pad called a “sail sign”

A

Elbow fracture!

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9
Q

What type of splint do you use for a elbow fracture

A

Long arm posterior splint

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10
Q

True or False..

Middle third of clavicle is involved in 80% of fractures

A

True

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11
Q

Most common injury associated with scapula fractures?

A

Rib fractures

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12
Q

MOI= direct trauma to shoulder with arm adducted

Type I-III: treat with sling immobilization, ice, analgesics, early ROM at 7-14 days
Type IV-VI: ortho for surg repair

A

AC joint injuries

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13
Q

Glenohumeral joint dislocations are most commonly ________ dislocations

A

Anterior

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14
Q

MC nerve injured with glenohumeral dislocations

(can be tested by testing sensation over lateral deltoid)

A

Axillary N

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15
Q

MC population of ppl who have prximal humerus (humeral head) fractures?
and MC MOI?

A

Elderly pts with osteoporosis, FOOSH

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16
Q

Pain, swelling, ecchymosis, tenderness, abnormal mobility

MC injury= axillary N

Tx= sling immobilization

A

Proximal humerus fracture

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17
Q

Fracture of the proximal ulna shaft with radial head dislocation

Presents with significant pain and swelling over elbow

*VERY obvious XRay

A

Monteggia Fracture-Dislocation

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18
Q

Fracture of the distal radius with an associated distal radioulnar joint dislocation

presents with localized swelling and tenderness over distal radius and wrist

*very obvious xray

A

Galeazzi Fracture-dislocation

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19
Q

Thumb ulnar collateral ligament rupture, AKA

A

Gamekeeper’s thumb

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20
Q

Forced radial abduction at MCP joint

tx= splint in thumb spica and refer

A

Gamekeeper’s thumb (thumb ulnar collateral ligament rupture)

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21
Q

increased pressure in a confined muscle compartment that results in functional and circulatory impairment of a limb

MC sites= legs and forearm

A

Compartment syndrome

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22
Q

normal tissue perfusion is <10 mmHg

comparment pressures of _______mmHg are detrimental to nerves and muscles

A

30-50 mmHg

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23
Q

Severe, out of proportion pain
pain with passive stretch

swollen, firm and tender to palpation
(color and temp are normal. pulses are felt until late in dz process)

A

Compartment syndrome

24
Q

A delta pressure of ______mmHg is used to diagnosed acute compartment syndrome

A

30 mmHg

25
Q

Tx=
surgical fasciotomy!!
elevate affeected limb to level of heart
remove any restrictive casts, dressings, etc

A

Comparment syndrome

26
Q

For compartment syndrome, the best outcomes happen if treatment occurs within…

A

6 hours

27
Q

Sulcus sign is seen with…

A

Glenohumeral dislocation

28
Q

MC shoulder dislocations are anterior

..what are the 2 causes of posterior dislocations?

A

Seizure
Lightening

29
Q

a dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front of the glenoid.

A

Hill-Sachs lesion

30
Q

Key exam finding for rotator cuff injury?

A

Limited ROM

31
Q

Which type of pelvic fracture is “stable” and pts can walk in

A

Ramus fracture

32
Q

What should you do before putting a foley in a pelvic fx patient

A

Check urethral opening for blood

33
Q

2 best images for pelvic fx pts

A

XRay
CT

34
Q

If pt has a negative xray but cannot walk, what image should you get next?

A

CT

(acetabular fractures do not always show up on xrays)

35
Q

Shortened and externally rotated

A

classic hip fracture

36
Q

Shortened and internally rotated

A

hip dislocation

37
Q

90% of hip dislocations are _______

A

posterior

(may have associated acetabular or femoral head fracture)

38
Q

If a hip fracture is not seen on XRAY, this image has a near 100% sensitivity for occult fractures

A

MRI

39
Q

Hallmark ED management for a femur fracture

A

Traction splint (Hare)

40
Q

If a pt has an open femur fracture, what do they need

A

Broad spectrum abx

41
Q

MC knee dislocations are _______

A

anterior

(spontaneous reduction occurs in ~50%)

42
Q

______ dislocations are more common in women and result from a twisting injury on an extended knee

A

patellar

43
Q

A high incidence of associated injuries to the popliteal artery and peroneal nerve, as well as ligaments and meniscus exists with…

A

knee dislocations

(aka why only ortho should deal with them)

44
Q

In a knee dislocation,

do normal distal pulses rule out popliteal artery injury?

A

NO

45
Q

What is the management of a knee dislocation?

A

Contact ortho ASAP!!!

Need immediate reduction
Admission is mandatory for obsevation of neurovascular status

46
Q

ACL tears account for ~___% of all hemarthroses

A

75%

ACL..positive Lachman, Anterior drawer

47
Q

Posterior drawer tests for…

A

PCL

48
Q

what is the most common, medial or lateral mensical injury?

A

medial!

bc it is connected to the MCL, whereas the lateral side is not connected to anything and can move more freely

49
Q

painful locking of knee
popping, clicking or snaping
sense of instability

+McMurrarys test (but not sensitive)

A

Meniscal injury

50
Q

What movement should you always ask your knee injury pts to do? and why?

A

Knee extension (to rule out quad rupture)

51
Q

MOI: valgus or varus forces combined with axial load that drives the femoral condyle into the tibia

Tx= non-displaced, unilateral fx: knee immobilizer with non weightbearing. refer to ortho 2-7 days

A

Tibial plateau fractures

THESE ARE VERY HARD TO SEE ON XRAY!!

52
Q

Bi and trimalleolar fractures required…

A

open reduction internal fixation (ORIF)

53
Q

Wet sterile dressing coverage
Splinting
Tetatnus
1st generation cephalosporin

…treatment for what kind of ankle fractures

A

Open fractures

54
Q

How should you splint an Achilles rupture?

A

Splint in full plantar flexion

55
Q

True or False…

calcaneal fractures usually happen bilaterally

A

True

56
Q

combination of spiral fracture of the proximal fibula and ankle injury which could manifest by widening of the ankle joint due to distal tibiofibular syndesmosis and/or deltoid ligament disruption, or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism

A

Maisonneuve fracture

(always check the proximal fibula for tenderness with an ankle injury)

SD- ER pt 2 (6 decks)

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