Acute Fractures

Question 1

supracondylar elbow fractures risk injury to what nerve and artery?

Answer 1

median nerve and brachial artery

Question 2

what is the most common comorbid nerve injury in a humeral shaft fracture?

Answer 2

radial nerve injury

Question 3

what type / location of humerus fracture is most associated with nerve injury?

Answer 3

transverse mid-diaphyseal fracture

Question 4

if intramedullary nailing is used to treat humerus fracture, what is the most common complication to warn the athlete about?

Answer 4

shoulder pain

Question 5

in most cases, what is the typical appropriate management for humerus shaft fracture?

Answer 5

non operative management / functional bracing/ROM and isometric exercises

Question 6

most distal humerus fractures require what type of treatment?

Answer 6

surgical stabilization

Question 7

what is the two step initial management for a patient with non displaced radial head fracture?

Answer 7

sling and early elbow ROM

Question 8

for non surgical management of distal radius fracture, for how long should immobilization in cast last?

Answer 8

4-6 weeks

Question 9

after 4-6 weeks casting for minimally displaced distal radius fracture, what is the next step?

Answer 9

removable splint

Question 10

most scaphoid fractures are treated in what way?

Answer 10

surgical - ORIF

Question 11

what imaging modality can be helpful for assessing healing of scaphoid fractures and return to play decisions?

Answer 11

CT

Question 12

an acute olecranon fracture that is < 2mm displaced and with intact extensor mechanism can be treated with what?

Answer 12

cast or splint immobilization

Question 13

in the case of a middle third clavicle fracture, the medial portion is pulled in what direction? by what muscle?

Answer 13

superiorly by the SCM muscle

Question 14

dislocations of the PIP should be treated with what type of splint?

Answer 14

extension block splint

Question 15

how are minimally displaced phalanx fractures of the hand treated?

Answer 15

buddy taping

Question 16

how are metacarpal neck or shaft fractures treated?

Answer 16

cast or splint

Question 17

what degree of overlap of a clavicle fracture indicates the need for surgery?

Answer 17

> 2cm

Question 18

t/f operative management of displaced midshaft clavicle fracture improves return to sport compared with non operative management

Answer 18

true

Question 19

t/f conservative care for midshaft clavicle fracture can increase risk of nonunion compared to operative management

Answer 19

true

Question 20

what is a monteggia fracture?

Answer 20

fracture of the ulna with dislocation of the radial head

Question 21

what is a Galeazzi fracture?

Answer 21

fracture of the radial shaft with injury to the distal radioulnar joint

Question 22

what is the recommended treatment for skeletally mature athletes with displaced radial or ulnar shaft fractures?

Answer 22

surgical treatment

Question 23

what is the typical time for return to sport after forearm fracture?

Answer 23

4-6 weeks

Question 24

how do you manage a non displaced ulnar fracture?

Answer 24

bracing or casting until clinical and radiographic evidence of fracture union

Question 25

in a concominant fracture of the ulna and radius diaphysis , after ORIF, for how long do you need to immobilize in a long arm cast post-surgery?

Answer 25

6-8 weeks

Question 26

in the most common type of Monteggia fracture, in what relative direction will the humeral head dislocate?

Answer 26

anterior

Question 27

in a fracture of the radius distal to the insertion of the pronator teres, the distal fragment of the radius will be pullsed into pronation by what muscle?

Answer 27

pronator quadratus

Question 28

what complication of radial and/or ulnar fracture can cause difficulty pronating the forearm due to elimination of natural radial lateral bowing?

Answer 28

malunion

Question 29

compartment syndrome of the forearm is most likely to occur in what compartment?

Answer 29

volar

Question 30

what two criteria must be met to treat a tibial plafond fracture with long leg cast?

Answer 30

1. minimal displacement 2. no damage to the articular joint surface

Question 31

what type of surgery is indicated for Jones fracture?

Answer 31

intramedullary screw fixation

Question 32

fractures of the foot that are minimally displaced can be treated with what?

Answer 32

short leg cast

Question 33

the duration for which a hip dislocation is ongoing is directly correlated to what complication of the femoral head?

Answer 33

osteonecrosis

Question 34

MRI performed after hip dislocation/reduction can assess for what two complications?

Answer 34

1. AVN 2. injury to labrum / capsule

Question 35

before reduction of a hip dislocation is attempted, what two things must you do?

Answer 35

1. radiographs 2. Neurovascular assessment

Question 36

what is an important complication from displaced femoral neck fracture?

Answer 36

AVN of the femoral head

Question 37

weakness in what muscle group is a common complication from anterograde intramedullary nailing for treatment of a femoral neck fracture?

Answer 37

abductor muscle weakness

Question 38

what is the typical mechanism of a knee dislocation?

Answer 38

hyperextension with foot fixed

Question 39

what is a normal ABI?

Answer 39

0.9 or greater

Question 40

which nerve function is especially important to assess after suspected knee dislocation?

Answer 40

peroneal nerve function

Question 41

what is the most common comorbid fracture in the case of knee dislocation?

Answer 41

tibial plateau fracture

Question 42

if you assess a knee dislocation and find that the pulses are different side to side, what is the next step?

Answer 42

eval for vascular injuries with CT or MR angiography

Question 43

what type of splint should be used for on field stabilization of tibial shaft fracture?

Answer 43

air or vacuum splint

Question 44

t/f in the case of tibial shaft fracture, you should splint the fracture as it lies

Answer 44

true

Question 45

which artery is most at risk in a knee dislocation?

Answer 45

popliteal artery

Question 46

anterior and posterior dislocation of the knee refer to what segment?

Answer 46

direction that the tibia moves in relationship to the femur

Question 47

what is a Maisonneuve fracture?

Answer 47

complete disruption of the tibiofibular syndesmosis, fracture of the proximal fibula and medial ankle injury (such as deltoid ligament tear)

Question 48

what is the typical movement of the talus that serves as the MOI for Maisonneuve fracture?

Answer 48

external rotation

Question 49

what is a type A rotational fracture of the ankle?

Answer 49

avulsion fracture of the lateral malleolus and shear fracture of the medial malleolus caused by medial rotation of the talus

Question 50

what is a type B rotational fracture of the ankle?

Answer 50

shear fracture of the lateral malleolus and avulsion fracture of the medial malleolus from lateral rotation of the talus

Question 51

what is a type C rotational ankle fracture?

Answer 51

disruption of the tibiofibular ligaments and syndesmosis by external rotation of the talus also resulting in more proximal fracture of the fibula

Question 52

how can closed, stable fractures of the tibial shaft be managed?

Answer 52

cast and functional bracing

Question 53

when performing external rotation stress testing of the ankle, if stability is found and there is no pain with this maneuver, what etiology can be mostly ruled out?

Answer 53

unstable ankle fracture

Question 54

the Weber system of ankle fracture classification classifies fractures in relationship to what structure?

Answer 54

tibial plafond

Question 55

when evaluating ankle fracture on XR, what are the cutoffs for increased widening at the medial clear space and at the distal tibiofibular space?

Answer 55

>4mm medial clear space >6mm tibiofibular space

Question 56

in general, what is the treatment for bimalleolar or trimalleolar fractures of the ankle?

Answer 56

ORIF

Question 57

what is the particular surgical treatment of choice for repair of the syndesmosis when diastasis is present?

Answer 57

suture fixation device such as Tight Rope

Question 58

what are the earliest and most reliable indicators of acute compartment syndrome?

Answer 58

pain out of proportion and pain with passive stretch

Question 59

what are the 5 p's of compartment syndrome?

Answer 59

pain pallor pulselessness paresthesia poikilothermia

Question 60

t/f firm compartments and severe pain, especially with passive stretch are adequate to make the diagnosis of compartment syndrome even in the absence of compartment testing

Answer 60

true

Question 61

how long should screws be left in place for a fifth metatarsal base fracture?

Answer 61

until the athlete has finished competitive sports