DSA: Sprains, Strains, & Fractures

Question 1

Ottawa Knee Rules

Answer 1

Question 2

Tibial Plateau Fracture

Answer 2

Question 3

Ottawa Ankle Rule

Answer 3

Question 4

Ankle Dislocation

Answer 4

Question 5

Lateral Malleolus Fracture

Answer 5

Question 6

Medial Malleolus Fracture

Answer 6

Question 7

Bimalleolar/Trimalleolar Fractures

Answer 7

Question 8

Maisonneuve Fracture

Answer 8

Question 9

Pilon/Tibial Plafond Fracture

Answer 9

Question 10

Calcaneal Body/Extra-articular Calcaneal Foot Fractures

Answer 10

Question 11

Midfoot Fracture

Answer 11

Question 12

Navicular Fracture

Answer 12

Question 13

Cuboid and Cuneiform Fractures

Answer 13

Question 14

Lisfranc Injury

Answer 14

Question 15

Metatarsal Fracture

Answer 15

Question 16

Proximal 5th Metatarsal Fracture

Answer 16

Question 17

Toe Fracture

Answer 17

Question 18

Toe Dislocation

Answer 18

Question 19

Open vs. Closed Fracture

Answer 19

• *Open fracture**: fracture with direct communication to the external environment
• *Closed fracture**: broken bone with no direct communication to the external environment

Question 20

What are the initial steps in managing a fracture in the ED?

Answer 20

Question 21

Define the following fracture types:

complete

tranverse

oblique

spiral

comminuted

incomplete (4 subtypes)

Answer 21

Question 22

What is an important rule on clinical imaging of joint injuries?

Answer 22

image the joint aboe and below

Question 23

What is the Salter-Harris classification used for?

Answer 23

description of physeal fractures in children

Question 24

When splinting an injury, what goes on the inner, middle, and outer layers?

Answer 24

Question 25

What complications can be seen with splinting?

Answer 25

compartment syndrome ischemia neurologic injury thermal injury pressure sore skin breakdown infection dermatitis joint stiffness

Question 26

It is important to document what in regards to physical findings?

Answer 26

document findings **before and after** splinting

Question 27

How much pain meds should be given?

Answer 27

no more then **3-7 days worth** (only give enough to get to next appointment)

Question 28

What is the MOA of femoral shaft fractures?

Answer 28

most commonly: MVC, penetrating tauma falls in elderly **non-accidental** trauma in kids

Question 29

When should you not use a traction splint in a femoral shaft fracture?

Answer 29

**concurrent fracture/dislocation of the ispilateral hip, knee of ankle**

Question 30

The pain with a fibula fracture is worsened with...

Answer 30

foot eversion

Question 31

What do you see on exam with MCL and LCL injuries?

Answer 31

MCL - joint laxity _without_ stress test LCL - joint laxiety _with_ varus stress test

Question 32

When do you need a consult with a patella dislocation?

Answer 32

**non-lateral dislocations** --\> often need surgery

Question 33

When is it especially important to get a CT with tibial plateau fractures?

Answer 33

**unexplained knee effusion**

Question 34

What are the indications for surgery with tibial plateau fractures?

Answer 34

**poly trauma** **communited fractures** **open fractures** **significant soft tissue injury** (--\> inc risk of compartment syndrome)

Question 35

Who does the Ottwa Ankle rules not apply to?

Answer 35

pregnant women intoxicated pts head injuries pts under 6

Question 36

What injuries are included in a Maisonneuve Fracture?

Answer 36

proximal fibula fracture distal tibiofibular syndesmosis injury deltoid ligament rupture _or_ medial malleolus fracture

Question 37

What injury may show a Mondor sign?

Answer 37

calcaneal body/extra articular **calcaneal foot fractures** Mondor sign - heel hematoma

Question 38

What is the most common fracture bone of the midfoot?

Answer 38

**navicular** most common subtype is dorsal avulsion fracture

Question 39

When viewing the cuboid vs. cuneiform, which images are best?

Answer 39

cuboid -medial oblique cuneiform - lateral and lateral oblique

Question 40

What injury usually requires CT to evaluate for occult fractures?

Answer 40

lisfranc injury

Question 41

What medications may be given in the ED to prevent future complications of a fracture?

Answer 41

**tetatnus prophylaxis** **IV ABs** (first gen cephalosporin, aminoglycoside, piperacillin...)

Question 42

What two Salter-Harris classification that can be easy to mix up?

Answer 42

**Type I** - transverse fracture thu physis **and** **Type V** - compression fracture thru physis * Type V is often dx retrospectively after arrest of growth * Suspect Type V if MOI involves significant axial load

Question 43

What is a unique indication for posterior knee splints?

Answer 43

**pt with legs too large for knee immbolizer** _others_: patella fracture/dislocation, patella or quads tendon injury, soft tissue injuries of the knee