Fractures & Trauma

Topics in this chapter

• Fracture Principles and Healing
• Wrist and Forearm Fractures
• Humerus Fractures and Nerve Injuries
• Hip and Femur Fractures
• Knee and Patellar Injuries
• Pediatric Fractures and Growth Plate Injuries
• Fracture Complications and Trauma Emergencies

Practice questions

1. Question 1Q-8D1FD0

   A 24-year-old male is brought to the emergency department following a high-speed motor vehicle collision. He has a closed fracture of the shaft of the femur. Over the next 24 hours, he develops confusion, petechial rashes over the anterior chest wall and axilla, and acute respiratory distress. Arterial blood gas analysis reveals hypoxemia. Which of the following is the most definitive early preventative measure for this complication?

   1. A.Administration of high-dose systemic corticosteroids
   2. B.Early stabilization and intramedullary nailing of the femoral fracture
   3. C.Prophylactic placement of an inferior vena cava filter
   4. D.Immediate therapeutic anticoagulation with low-molecular-weight heparin
   See the answer and solution
2. Question 2Q-3BD283

   A 32-year-old construction worker falls from a ladder and sustains an injury to his right wrist. Examination reveals swelling, pain, and tenderness specifically in the anatomic snuffbox, along with pain on axial compression of the thumb. Initial plain radiographs of the wrist show no obvious fracture. What is the most appropriate next step in management?

   1. A.Discharge with reassurance and advise no imaging is needed
   2. B.Apply a thumb spica cast and obtain follow-up radiographs or advanced imaging in 10-14 days
   3. C.Perform open reduction and internal fixation immediately
   4. D.Order a standard bone scintigraphy immediately
   See the answer and solution
3. Question 3Q-11C521

   A 70-year-old osteoporotic female trips and falls on her outstretched hand. She presents with a painful, deformed right wrist. Examination reveals a 'dinner-fork' deformity. Radiographs show a extra-articular distal radius fracture with dorsal displacement and dorsal tilt. What is the eponym for this fracture?

   1. A.Smith fracture
   2. B.Colles fracture
   3. C.Barton fracture
   4. D.Galeazzi fracture
   See the answer and solution
4. Question 4Q-F4346D

   A 10-year-old boy falls from a jungle gym and injures his left elbow. On examination, there is marked swelling, pain, and an inability to move the elbow. Radiographs reveal a fracture of the distal humerus extending through the physis and epiphysis, entering the joint. According to the Salter-Harris classification, how is this fracture categorized?

   1. A.Salter-Harris Type I
   2. B.Salter-Harris Type II
   3. C.Salter-Harris Type III
   4. D.Salter-Harris Type IV
   See the answer and solution
5. Question 5Q-8821B5

   A 45-year-old male is rescued from a motor vehicle wreckage with a severely crushed right lower leg. Two hours after admission, he complains of severe, unrelenting pain in the calf that is out of proportion to the physical findings and is worsened by passive stretch of the toes. Pulses are intact, and capillary refill is normal. Which of the following is the most appropriate immediate diagnostic or therapeutic intervention?

   1. A.Reassure and administer intravenous narcotics
   2. B.Urgent measurement of compartment pressures or emergency fasciotomy
   3. C.Apply warm compresses and elevate the limb above the heart
   4. D.Order an emergency duplex ultrasound for deep vein thrombosis
   See the answer and solution