Orthopedic

Question 1

What is the sensitivity of the Ottowa Ankle Rules

Answer 1

Approaches 100%

Question 2

What are three criteria for Ottowa ankle rules in addition to PAIN in malleolar region.

Answer 2

1. Tenderness in posterior 6cm medial malleolus or
2. Tenderness in anterior 6cm of lateral malleolus or
3. Inability to bear weight immediately and in the ED

Question 3

What are the three criteria for the Ottowa foot rules in addition to PAIN in the midfoot region

Answer 3

1. Tenderness at the base of the 5th metatarsal or
2. Tenderness of the navicular or
3. Inability to bear weight immediately and in the ED

Question 4

Who should Ottowa ankle rules not be applied to?

Answer 4

1. Intoxicated
2. Multiple trauma
3. Head injuries
4. Decreased sensation/neuro deficit

Question 5

What does comminuted mean?

Answer 5

A fracture with more than two pieces

Question 6

In a patient that has a pulseless limb following a fracture, how can you try to restore blood flow?

Answer 6

You can try to gently reduce the fracture with gentle traction until blood flow is restored

Question 7

What antibiotics should you use for open fractures?

Answer 7

1. 1st generation cephalosporin (cefazolin)

2. Add aminoglycoside for Grade II and III fractures

Question 8

How should you cover an open fracture?

Answer 8

With sterile wet dressing

Question 9

What are the clinical symptoms of compartment syndrome?

Answer 9

Pain
Pallor
Paralysis
Parasthesias
Pulselessness

Question 10

How do you diagnose compartment syndrome?

Answer 10

Pressure manometry

1. Compartments usually ~ 0
2. > 30 requires intervention

Question 11

A femur can hold how much blood?

Answer 11

1000 ml

Question 12

A pelvic fracture can hold how much blood?

Answer 12

3000 ml

Question 13

Fractures of what bones are associated with avascular necrosis?

Answer 13

1. Scaphoid
2. Capitate
3. Talus
4. Femoral head

Question 14

If you’re concerned about a fracture, but xrays are negative, what should you do?

Answer 14

Splint and reimage in 7-10 days

Question 15

Why are splints better than casts in the ED?

Answer 15

They allow for soft-tissue swelling as the injury as the acute injury progresses

Question 16

What is a buckle fracture?

Answer 16

Where the cortex is caved in a little bit, but the fracture is incomplete

Question 17

A patient with monoarticular arthritis is what?

Answer 17

Septic arthritis until proven otherwise

Question 18

How is fever associated with septic arthritis?

Answer 18

Not always there. Absence of fever doesn’t RO SA