Orthopedic Trauma Day 1

Question 1

what does an open fracture require?

Answer 1

emergent orthopaedic care for surgical I&D and reduction

Question 2

what is the treatment for an open fracture? (4)

Answer 2

irrigation at bedside with NS
wound dressing
IV antibiotics
tetanus

Question 3

most shoulder dislocations (>90%) are classified as _____

Answer 3

anterior

Question 4

shoulder dislocation puts what nerve at risk?

Answer 4

axillary nerve

Question 5

what should always be done before and after a reduction?

Answer 5

neurovascular exam

Question 6

what is the key to any reduction? (2)

Answer 6

relaxation
muscle fatigue

Question 7

what is the treatment for shoulder dislocation? (2)

Answer 7

sling
gentle, progressive ROM exercises

Question 8

what is the most common physical finding of a posterior shoulder dislocation?

Answer 8

shoulder locked in internal rotation

Question 9

what must you get after any reduction?

Answer 9

xray

Question 10

axillary view; is this an anterior or posterior dislocation?

Answer 10

anterior

Question 11

axillary view; is this an anterior or posterior dislocation?

Answer 11

anterior

Question 12

an injury of the anterior (inferior) glenoid labrum of the shoulder

Answer 12

bankart lesion

Question 13

when does a bankart lesion occur?

Answer 13

when glenoid labrum is disrupted with shoulder dislocation

Question 14

what is the treatment for bankart lesion?

Answer 14

surgery

Question 15

a bankart lesion is often accompanied by a _____ _____

Answer 15

Hill-Sachs lesion

Question 16

what is the arrow pointing at?

Answer 16

Bankart lesion

Question 17

cortical depression in the posterolateral head of the humerus that results from forceful impaction of the humeral head against the glenoid rim when the shoulder is dislocated anteriorly

Answer 17

Hill-Sachs lesion

Question 18

identify

Answer 18

Hill-Sachs lesion

Question 19

how can most clavicle fractures be treated?

Answer 19

sling

Question 20

which portion of the clavicle is most frequently injured?

Answer 20

middle

Question 21

which 2 muscles assist in dislocation of the clavicle?

Answer 21

pectoralis going down
sternocleidomastoid going up

Question 22

what should we check for on physical exam if a patient has a possible clavicle injury? (2)
to rule out what?

Answer 22

skin tenting + NV exam
to rule out brachial plexus injury

Question 23

what imaging should we do for a fracture of the proximal clavicle? what joint should we examine?

Answer 23

CT scan
sternoclavicular joint

Question 24

what is the treatment for a fracture of the proximal clavicle?

Answer 24

non-op

Question 25

what is an absolute surgical indication for a fracture of the middle clavicle? (2)

Answer 25

open injury impending open "skin tenting"

Question 26

what are 5 relative surgical indications for a fracture of the middle clavicle?

Answer 26

> 2cm displaced comminution neuro compromise nonunion with pain/limited ROM x 4 weeks cosmetic/patient discomfort

Question 27

identify

Answer 27

fracture of the middle clavicle

Question 28

fracture of which part of the clavicle is most likely to nonunion?

Answer 28

distal clavicle

Question 29

what is the most common treatment for fracture of the distal clavicle?

Answer 29

mostly non-op but controversial

Question 30

displaced or non-displaced?

Answer 30

non-displaced

Question 31

displaced or non-displaced?

Answer 31

displaced

Question 32

a proximal humerus fracture is most common in which patients?

Answer 32

elderly with osteoporosis

Question 33

injury to which nerve is most commonly associated with proximal humerus fracture?

Answer 33

axillary nerve

Question 34

what is the most common treatment for proximal humerus fracture? (2)

Answer 34

non-op (sling and preserve ROM)

Question 35

what does treatment for a proximal humerus fracture depend on? (7)

Answer 35

age fracture type fracture displacement bone quality dominance general medical condition concurrent injuries

Question 36

a 72 yo patient presents with this. Dx? displaced vs non-displaced? operative vs non-operative?

Answer 36

proximal humerus fracture displaced non-operative d/t age

Question 37

what can we offer if a patient wants a surgical option for a proximal humerus fracture?

Answer 37

shoulder replacement

Question 38

24 yo patient presents with this. Dx? operative vs nonoperative?

Answer 38

proximal humerus fracture w/ severe comminution operative