ORTHO

Question 1

Is everything in ortho able to diagnose with xrays?

Answer 1

No… duh

Question 2

Where does a clavicle fracture typically occur?

Answer 2

Distal 1/3

Question 3

What physical exam finding is of the biggest concern with a clavicle fracture?

Answer 3

Look at the skin! If you see tenting it will convert into an open fracture

And make sure they don’t hurt at the sternoclavicular joint

And no neuro findings!

Question 4

How do you treat a clavicle fracture?

Answer 4

Should immobilizer & sleep upright if need be

Question 5

What’s it called when there is shortening?

Answer 5

Beynnett

Question 6

What are the grades of an AC joint separation?

Answer 6

Grade 1-3

Question 7

How do you treat an AC separation?

Answer 7

sling

Question 8

Who do most commonly see humeral head fractures in and what MOI?

Answer 8

elderly with FOOSH

Question 9

How do we treat humeral head fractures?

Answer 9

Typically conservative

Question 10

If you find a scapula injury, what do you need to think?

Answer 10

There is most likely other trauma

Question 11

What should we never say after an xray?

Answer 11

Don’t say: “Everything is okay”. Say: “I do not see obvious bony injury BUT we can’t see soft issue injury”

Question 12

What’s the MOI for a shoulder dislocation?

Answer 12

Abd & Ext rotation

Question 13

What will you see on PE with a shoulder dislocation?

Answer 13

Sulcus sign that you can place your thumb into it

Question 14

What should we rule out with a shoulder dislocation?

Answer 14

Fracture & neuromuscular and a Hill-Sachs deformity

Question 15

What would cause a posterior dislocation in an unconscious patient?

Answer 15

Seizure and Electrocution

Question 16

What’s a good pain medication for shoulder dislocations?

Answer 16

Fentanyl (since it wears off quickly)

Question 17

What should we ask about in history for shoulder dislocations?

Answer 17

Ask about prior dislocations & how long it has been out for & which hand is dominant

Question 18

If a patient has a hill-sachs deformity, how difficult is it to relocate?

Answer 18

VERY (will often need full sedation)

Question 19

What image would prove shoulder relocation?

Answer 19

Y (with humeral head touching all 3 views)

Question 20

Once the shoulder is reduced, what do you do?

Answer 20

post reduction films, recheck neurovascular, and tell them to avoid abd/ext rot

Question 21

Limited flexion ROM (can’t go past 90 degrees) is key in what diagnosis?

Answer 21

Rotator cuff injury

Question 22

how do you treat a RTC tear?

Answer 22

Sling → send to ortho

Question 23

What are the common elbow fractures?

Answer 23

Supercondylar (bad)

Radial head

Olecranon

Question 24

If you see a distal humeral fracture in a child – what do you do?

Answer 24

REFER!!!! It’s a supracondylar fracture that is so likely to produce long term effects

Question 25

A sail sign is for what?

Answer 25

Proximal radial head fracture

Question 26

When do we see a posterior fat pad in the elbow?

Answer 26

Only when there is an injury; again proximal radial head fracture

Question 27

What type of splint for a proximal radial head fracture?

Answer 27

Long arm

Question 28

Which way does an elbow dislocate?

Answer 28

Posterior

Question 29

After an elbow reduction, what do you do?

Answer 29

Are they neuromuscular intact - | have radiologist or ortho confirm that there’s no radial head fx

Question 30

How do you reduce an elbow?

Answer 30

Countertraction, then pull out and flex forward

Question 31

What’s special about the scaphoid?

Answer 31

Limited blood supply → high rate of non-unions

Question 32

When do you need to handle a wrist injury rather than splinting and sending to ortho later?

Answer 32

Severely angulated or displaced

Question 33

What splint for a distal radius?

Answer 33

volar

Question 34

Any time you find a fracture in a two-bone structure what must you do?

Answer 34

Either crazy palpate or image higher up

Question 35

What fractures in the wrist/forearm do you not want to miss?

Answer 35

Monteggia or Galiazzi

Question 36

What does a positive finkelstein’s test?

Answer 36

DeQuervan’s

Question 37

What does a positive tinel’s test?

Answer 37

Carpal tunnel

Question 38

How do you treat carpal tunnel?

Answer 38

Splint day & night

Question 39

If a patient has a hyperextension injury of the thumb – what diagnosis?

Answer 39

Gamekeeper’s Thumb

Question 40

What must you test for gamekeeper’s?

Answer 40

MCL injury

Question 41

If a grandma fell and her hip hurts and she won’t walk – what does that mean? What should you do?

Answer 41

There is most definitely something wrong → most likely an acetabular fracture CT hip

Question 42

What hip fracture is stable and the person can walk in on it?

Answer 42

Ramus or pelvic ring fractures

Question 43

If you break higher up in the crest portion of the hip – will they walk on it?

Answer 43

Nope

Question 44

What should you look for on PE in a pelvic fracture?

Answer 44

Crepitus, instability, weight bear, and rotation

Question 45

Shortened and internally rotated hip is what?

Answer 45

Dislocation

Question 46

What should you press onto to rule out significant injury in a pelvic injury?

Answer 46

Iliac crests – if you not crepitus → get trauma

Question 47

What parts of body can you bleed into?

Answer 47

Head, chest, pelvis, and femur

Question 48

Where is an open book fracture?

Answer 48

Pubic symphysis

Question 49

What do you need to make sure or with a pelvic fracture (downtown)?

Answer 49

Make sure there’s no tear in their urethra → no blood present

Question 50

What happens to hip fracture patients?

Answer 50

They get admitted

Question 51

What classification system can we use for hip fractures?

Answer 51

Garden classification

Question 52

If a patient cannot walk on their hip and their leg is externally rotated – what diagnosis is most likely?

Answer 52

Hip fracture

Question 53

Who would most commonly dislocate their hip?

Answer 53

total hip patients

Question 54

Which way do most hips dislocate?

Answer 54

Posterior

Question 55

How do you manage a femur fraction in the ED?

Answer 55

Traction splint (Hare) → Surgical fixation is always necessary

Question 56

If you have a patient with a suspected femur fracture, what must you remember?

Answer 56

Rule out any other injuries!!!

Question 57

If there is some type of neurovascular compromise in a femur fracture, what must you do?

Answer 57

Pull traction

Question 58

If you see a kid with a femur fracture – what must you suspect?

Answer 58

Child abuse

Question 59

If a patient presents with a plant and twist mechanism with minimal pain?

Answer 59

ACL

Question 60

PE findings of ACL tear?

Answer 60

+ Anterior drawer & + Lachman’s

Question 61

PE findings for meniscal tear?

Answer 61

joint line tenderness & + Valgus

Question 62

What is the meniscus connected to?

Answer 62

MCL

Question 63

IF you have a true knee dislocation – what do you do?

Answer 63

DO NOT DO ANYTHING WITH IT! Call ortho for EMERGENT consult Why? Because of the popliteal artery, and you assume neurovascular accident

Question 64

We should ALWAYS check AROM in the knee – what are we ruling out?

Answer 64

Quad or patellar tendon rupture

Question 65

What is difficult about tibial plateau fractures?

Answer 65

easy to miss & often don’t heal well

Question 66

What must you always note on ankle xray?

Answer 66

Is the mortise intact

Question 67

Which ankle injury is most common?

Answer 67

Lateral malleolus

Question 68

If there is an ankle fracture what MUST you check, in order to rule out what?

Answer 68

DOCUMENT NO PROXIMAL TIBIAL TENDERNESS In order to rule out a maisoneuve injury

Question 69

If you have a bi or tri-malleolar fracture what happen to the mortise joint?

Answer 69

It is unstable

Question 70

A positive Thompson test is for what?

Answer 70

Achilles rupture

Question 71

How do you splint an Achilles tendon rupture?

Answer 71

Full plantar flexion

Question 72

If you have a calcaneal fracture in the right side – what must you rule out?

Answer 72

ALWAYS x-ray the other foot ALWAYS examine the spine!