Chapter 31: Orthopaedic Injuries

A 21-year-old male was thrown over the handlebars of his motorcycle when he rear-ended a car that was stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious, but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting his spine, you should: A. bind his legs together on the backboard, keep him warm, and transport without delay. B. apply traction splints to both of his legs, keep him warm, and transport without delay. C. splint each of his deformed femurs with long board splints and transport immediately. D. apply the PASG to stabilize his femurs and transport at once.

A

A 31-year-old male fell and landed on his left elbow. Your assessment reveals that the elbow is grossly deformed, his forearm is cool and pale, and the distal pulse on the side of the injury is barely palpable. His vital signs are stable and he denies any other injuries. Your transport time to the closest appropriate hospital is approximately 15 minutes. You should: A. splint the elbow in the position found and transport. B. gently manipulate the elbow to improve circulation. C. gently straighten the elbow and apply an air splint. D. apply a heat pack to the elbow to reduce swelling.

A

A _______ is a stretching or tearing of the muscle. A. strain B. sprain C. torn ligament D. split

A

A(n) _______ fracture is an incomplete fracture that passes only partway through the shaft of a bone but many still cause severe angulation. A. greenstick B. comminuted C. pathologic D. epiphyseal

A

A(n) _______ fractures the bone at the point of impact. A. direct blow B. indirect force C. twisting force D. high-energy injury

A

Blood in the urine is known as: A. hematuria. B. hemotysis. C. hematocrit. D. hemoglobin.

A

Deformity caused by a fracture would MOST likely be masked by: A. swelling. B. guarding. C. crepitus. D. ecchymosis.

A

Femoral shaft fractures can result in up to _____ mL of internal blood loss. A. 1,000 B. 1,500 C. 2,000 D. 4,000

A

In moving joints, the ends of the bones are covered with: A. articular cartilage. B. synovial tendons. C. muscular fascia. D. gliding cartilage.

A

Of the following musculoskeletal injuries, which is considered to be the LEAST severe? A. nondisplaced pelvic fracture B. open fractures of a long bone C. an amputation of an extremity D. multiple closed long bone fractures

A

The MOST common and significant complication associated with fractures or dislocations of the knee is: A. neurovascular compromise. B. internal bleeding and shock. C. ligament and cartilage damage. D. total depletion of synovial fluid.

A

The MOST commonly fractured bone(s) in the body is the: A. clavicle. B. scapula. C. radius and ulna. D. midshaft femur.

A

The act of pulling on a body structure in the direction of its normal alignment is called: A. traction. B. reduction. C. stabilization. D. immobilization.

A

The bones in the skeleton produce _______ in the bone marrow. A. blood cells B. minerals C. electrolytes D. hormones

A

The pectoral girdle consists of the: A. scapulae and clavicles. B. clavicles and rib cage. C. sternum and scapulae. D. acromion and clavicles.

A

The primary purpose for splinting a musculoskeletal injury is to: A. prevent further injury. B. maximize distal circulation. C. make the patient comfortable. D. facilitate ambulance transport.

A

When caring for a patient with a possible fracture of the scapula, the EMT should: A. carefully assess the patient for breathing problems. B. apply rigid board splints across the chest and back. C. assume that minimal force was applied to the back. D. recognize that scapular fractures are life threatening.

A

Which of the following joints allows no motion? A. skull sutures B. sacroiliac joint C. shoulder joint D. sternoclavicular joint

A

Which of the following scenarios is an example of a direct injury? A. A passenger fractures her patella after it strikes the dashboard. B. A skier dislocates his knee after a twisting injury to the ankle. C. A person lands on his or her feet and fractures the lumbar spine. D. A child dislocates his elbow after falling on his outstretched arm.

A

Which of the following statements regarding compartment syndrome is correct? A. Compartment syndrome typically develops within 6 to 12 hours after an injury. B. Compartment syndrome occurs because of increased pressure within the bone cavity. C. In most cases, compartment syndrome develops within a few minutes after an injury. D. Most cases of compartment syndrome occur following a severe fracture of the pelvis.

A

You receive a call to a local gymnasium for a basketball player with a dislocated shoulder. Upon arrival, you find the patient, a 17-year-old male, sitting on the ground. He is holding his left arm in a fixed position away from his body. There is an obvious anterior bulge to the area of injury. You should: A. assess distal pulse, motor, and sensory functions. B. gently attempt to move his arm toward his body. C. place a pillow under his arm and apply a swathe. D. flex his arm at the elbow and then apply a sling.

A

You respond to a 19-year-old woman who was involved in a motor vehicle collision. She is alert and oriented. Her airway is open, and respirations are 18 breaths/min and unlabored. Pulse is 94 beats/min and is strong and regular. Distal pulses are present. Her upper arm has obvious deformity. You splint the upper arm. You know that splinting will do all of the following EXCEPT: A. prevent the need for surgery. B. reduce shock. C. minimize compromised circulation. D. reduce pain.

A

You respond to a 19-year-old woman who was kicked in the leg by a horse. She is alert and oriented. Respirations are 20 breaths/min, regular and unlabored. Pulse is 110 beats/min and regular. Distal pulses are present. She has point tenderness at the site of the injury. You should compare the limb to: A. the opposite uninjured limb. B. one of your limbs or one of your partner's limbs. C. an injury chart. D. none of the above.

A

Your 24-year-old patient fell off a balance beam and landed on his arm. He is complaining of pain in the upper arm, and there is obvious swelling. You know that swelling is a sign of: A. bleeding. B. laceration. C. a locked joint. D. compartment syndrome.

A

The musculoskeletal system refers to the: A. bones and voluntary muscles of the body. B. nervous system's control over the muscles. C. connective tissue that supports the skeleton. D. involuntary muscles of the nervous system.

A. bones and voluntary muscles of the body Page 1087

A 45-year-old female was the unrestrained passenger of a small car that rear-ended another vehicle at a moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is visible damage to the dashboard on the passenger's side of the vehicle. In addition to fractures or dislocations of the knees, you should be MOST suspicious for: A. anterior hip dislocation. B. posterior hip dislocation. C. a thoracic spine fracture. D. fracture of the tibia or fibula.

B

A Colles fracture involves a fracture of the: A. distal ulna. B. distal radius. C. proximal radius. D. radius and ulna.

B

A _______ is a disruption of a joint in which the bone ends are no longer in contact. A. torn ligament B. dislocation C. fracture dislocation D. sprain

B

A ____________ is a musculoskeletal injury in which there is partial or temporary separation of the bone ends as well as partial stretching or tearing of the supporting ligaments. A. strain B. sprain C. fracture D. dislocation

B

A fracture caused by minimal force that is associated with diseases such as cancer and osteoporosis is called a __________ fracture. A. greenstick B. pathologic C. transverse D. comminuted

B

A fracture is MOST accurately defined as a(n): A. total loss of function in a bone. B. break in the continuity of the bone. C. disruption in the midshaft of a bone. D. abnormality in the structure of a bone.

B

A person who experiences a calcaneus fracture after jumping and landing on his or her feet would MOST likely experience an accompanying fracture of the: A. thoracic spine. B. lumbar spine. C. coccygeal spine. D. symphysis pubis.

B

A supracondylar or intercondylar fracture is also known as a fracture of the: A. radial head. B. distal humerus. C. proximal radius. D. olecranon process.

B

A(n) _______ is a fracture in which the bone is broken into two or more fragments. A. greenstick B. comminuted C. pathologic D. epiphyseal

B

A(n) _______ may cause a fracture or discoloration at a distant point. A. direct blow B. indirect force C. twisting force D. high-energy injury

B

Applying ice to and elevating an injured extremity are performed in order to: A. prevent further injury. B. reduce pain and swelling. C. enhance tissue circulation. D. maintain extremity perfusion.

B

Common signs and symptoms of a sprain include all of the following, EXCEPT: A. swelling. B. deformity. C. ecchymosis. D. point tenderness.

B

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should: A. splint the elbow in the position of deformity and transport immediately. B. apply gentle manual traction in line with the limb and reassess for a pulse. C. carefully straighten the injured arm and secure it with padded board splints. D. make two or three attempts to restore distal circulation by manipulating the elbow.

B

During your rapid secondary assessment of a 19-year-old female with multiple trauma, you note bilateral humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is rapid and weak. Your partner has appropriately managed her airway and is maintaining manual stabilization of her head. The MOST appropriate treatment for this patient includes: A. applying and inflating the pneumatic antishock garment (PASG) and transporting. B. immobilizing her to a backboard and rapidly transporting. C. applying a traction splint to immobilize her femur. D. carefully splinting each of her deformed extremities.

B

If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting: A. distal circulation. B. the patient history. C. bruising to the shoulder. D. the presence of deformity.

B

In general, musculoskeletal injuries should be splinted before moving the patient unless: A. the patient is in severe pain. B. the patient is clinically unstable. C. deformity and swelling are present. D. transport time is less than 15 minutes.

B

Regardless of the extent and severity of the damage to the skin, you should treat any injury that breaks the skin as a possible: A. closed fracture. B. open fracture. C. nondisplaced fracture. D. displaced fracture.

B

Smooth muscle is found in the: A. back. B. blood vessels. C. heart. D. all of the above.

B

The PASG is absolutely contraindicated in patients who have: A. pelvic fractures. B. pulmonary edema. C. bilateral femur fractures. D. any trauma below the pelvis.

B

When assessing a patient with a possible fracture of the leg, the EMT should: A. assess proximal circulation. B. compare it to the uninjured leg. C. carefully move it to elicit crepitus. D. ask the patient to move the injured leg.

B

When splinting a possible fracture of the foot, it is MOST important for the EMT to: A. use a pillow as a splint. B. leave the toes exposed. C. apply a pneumatic splint. D. observe for tissue swelling.

B

Which of the following injuries would be appropriate to treat with a traction splint? A. Injuries of the pelvis B. An isolated femur fracture C. Partial amputation or avulsions with bone separation D. Lower leg or ankle injury

B

Which of the following statements about compartment syndrome is FALSE? A. It occurs 6 to 12 hours after an injury. B. It most commonly occurs with a fractured femur. C. It is usually a result of excessive bleeding, a severely crushed extremity, or the rapid return of blood to an ischemic limb. D. It is characterized by pain that is out of proportion to the injury.

B

Which of the following types of muscle is under direct voluntary control of the brain? A. cardiac B. skeletal C. smooth D. autonomic

B

_______ are held together in a tough fibrous structure known as a capsule. A. Tendons B. Joints C. Ligaments D. Bones

B

Bone marrow produces: A. platelets. B. blood cells. C. lymphocytes. D. electrolytes.

B Page 1089

Skeletal muscle is also referred to as __________ muscle. A. smooth B. striated C. connective D. involuntary

B. striated Page 1087

Skeletal muscle is attached to the bone by tough, ropelike fibrous structures called: A. fascia. B. tendons. C. cartilage. D. ligaments.

B. tendons Page 1087-1088

A 17-year-old football player collided with another player and has pain to his left clavicular area. He is holding his arm against his chest and refuses to move it. Your assessment reveals obvious deformity to the midshaft clavicle. After assessing distal pulse, sensory, and motor functions, you should: A. perform a rapid secondary assessment. B. straighten his arm and apply a board splint. C. immobilize the injury with a sling and swathe. D. place a pillow under his arm and apply a sling.

C

A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the knee. Distal circulation and sensory and motor functions are intact. The MOST appropriate method of splinting this injury involves: A. applying a traction splint to realign the deformity. B. applying and fully inflating the pneumatic antishock garment (PASG). C. applying padded board splints to both sides of the leg. D. binding the legs together and elevating them 6″ to 8″.

C

A 77-year-old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her head or losing consciousness. Assessment of her left leg reveals that it is shortened and externally rotated. Distal pulses, sensory, and motor functions are intact. You should: A. manually stabilize her left leg, apply a traction splint, and then secure her to a long backboard or scoop. B. carefully slide a long backboard underneath her, keep her in a supine position, and apply a splint to her leg. C. place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps. D. bind both of her legs together with triangular bandages and carefully secure her onto the ambulance stretcher.

C

A _______ is an injury to the ligaments, the articular capsule, the synovial membrane, and the tendons crossing the joint. A. dislocation B. strain C. sprain D. torn ligament

C

A subluxation occurs when: A. ligaments are partially severed. B. a fracture and a dislocation exist. C. a joint is incompletely dislocated. D. a bone develops a hairline fracture.

C

A(n) _______ is also known as a hairline fracture. A. closed fracture. B. open fracture. C. nondisplaced fracture. D. displaced fracture.

C

A(n) __________ fracture occurs in the growth section of a child's bone and may lead to bone growth abnormalities. A. greenstick B. diaphyseal C. epiphyseal D. metaphyseal

C

Assessing a person's neurovascular status following a musculoskeletal injury includes all of the following, EXCEPT: A. assessing motor function. B. assessing sensory function. C. evaluating proximal pulses. D. determining capillary refill.

C

Crepitus and false motion are: A. indicators of a severe sprain. B. only seen with open fractures. C. positive indicators of a fracture. D. most common with dislocations.

C

During your rapid secondary assessment of a 30-year-old male who fell 25′, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should: A. defer spinal immobilization and transport to a trauma center. B. perform a focused physical exam with emphasis on the pelvis. C. stabilize the pelvis with a pelvic binder and protect the spine. D. log roll the patient onto a long backboard and transport at once

C

Fractures are almost always associated with _______ of the surrounding soft tissue. A. laceration B. crepitus C. ecchymosis D. swelling

C

In which of the following situations should the EMT splint an injured limb in the position of deformity? A. when distal circulation and neurological functions are absent B. if transport time to the hospital is greater than 20 to 30 minutes C. if resistance is encountered or the patient experiences severe pain D. if a traction splint will be used to immobilize the injured extremity

C

In-line _______ is the act of exerting a pulling force on a body structure in the direction of its normal alignment. A. stabilization B. immobilization C. traction D. direction

C

Joints are bathed and lubricated by _______ fluid. A. cartilaginous B. articular C. synovial D. cerebrospinal

C

Signs and symptoms of sprains include all of the following EXCEPT: A. point tenderness. B. pain preventing the patient from moving or using the limb normally. C. marked deformity. D. instability of the joint indicated by increased motion.

C

Traction splints are used primarily to immobilize and secure fractures of the: A. hip. B. pelvis. C. femur. D. humerus.

C

When caring for patients who have fallen, you must identify the _______ and the mechanism of injury so that you will not overlook associated injuries. A. site of injury B. height of fall C. point of contact D. twisting forces

C

Which of the following fractures has the greatest potential for internal blood loss and shock? A. hip B. femur C. pelvis D. humerus

C

Which of the following statements regarding shoulder dislocations is MOST correct? A. Posterior dislocations are most common. B. They are caused by forced arm adduction. C. Most shoulder dislocations occur anteriorly. D. They involve the acromion process and humerus.

C

With regard to musculoskeletal injuries, the zone of injury is defined as the: A. area of obvious deformity over the site of impact. B. exact part of the bone or joint that was disrupted. C. area of soft-tissue damage surrounding the injury. D. part of the body that sustained secondary injury.

C

You are called to the local assisted living facility where a 94-year-old man has fallen. He is alert and oriented and denies passing out. His respirations are 18 breaths/min and regular. Pulse is 106 beats/min, regular, and strong. Distal pulses are present. He states that he was walking and heard a pop and fell to the floor. You suspect a(n): A. greenstick B. comminuted C. pathologic D. epiphyseal

C

You have applied a zippered air splint to a patient's left arm. During transport, the patient complains of increased numbness and tingling in his left hand. You reassess distal circulation and note that it remains present. Your MOST appropriate action should be to: A. elevate the injured arm and reassess distal sensory function. B. inflate the splint with more air until the patient is comfortable. C. assess the amount of air in the splint and let air out as necessary. D. remove the air splint and reimmobilize with padded board splints.

C

_______ is the most reliable indicator of an underlying fracture. A. Crepitus B. Deformity C. Point tenderness D. Absence of distal pulse

C

Which of the following structures is regulated by smooth muscle? A. heart B. skeleton C. blood vessels D. diaphragm

C. blood vessels Page 1088

Atrophy is a condition that occurs when: A. increased use of skeletal muscle causes an increase in its strength. B. the tendons that attach muscle to bone become stretched or injured. C. muscle decreases in size and function because of disease or trauma. D. carbon dioxide, lactic acid, and other wastes accumulate in the muscle.

C. muscle decreases in size and function because of disease or trauma. Page 1087

A "hip" fracture is actually a fracture of the: A. pelvic girdle. B. femoral shaft. C. pubic symphysis. D. proximal femur.

D

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should: A. apply manual stabilization to both of her femurs. B. administer oxygen and perform a rapid assessment. C. assess for a carotid pulse and assist her ventilations. D. stabilize her head and perform a primary assessment.

D

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should: A. assess distal pulses as well as sensory and motor functions. B. manually stabilize the leg above and below the site of injury. C. gently manipulate the injured leg until the numbness dissipates. D. control the bleeding and cover the wound with a sterile dressing.

D

A(n) _______ fracture occurs in a growth section of a child's bone, which may prematurely stop growth if not properly treated. A. greenstick B. comminuted C. pathologic D. epiphyseal

D

A(n) _______ fracture produces actual deformity, or distortion, of the limb by shortening, rotating, or angulating it. A. closed fracture. B. open fracture. C. nondisplaced fracture. D. displaced fracture.

D

Always check neurovascular function: A. after any manipulation of the limb. B. before applying a splint. C. after applying a splint. D. all of the above.

D

An open fracture is MOST accurately defined as a fracture in which: A. bone ends protrude through the skin. B. a large laceration overlies the fracture. C. a bullet shatters the underlying bone. D. the overlying skin is no longer intact.

D

Bones are connected to other bones by bands of tough fibrous tissues called: A. bursa. B. tendons. C. cartilage. D. ligaments.

D

Following direct trauma to the left upper back, a 44-year-old male presents with diaphoresis and restlessness. His blood pressure is 100/50 mm Hg, his pulse rate is 120 beats/min and weak, and his respirations are 24 breaths/min and labored. Your assessment reveals abrasions and contusions over the left scapula. You should: A. hyperventilate him with a bag-mask device and monitor his oxygen saturation. B. apply high-flow oxygen, perform a detailed secondary assessment, and transport. C. focus your assessment on his scapulae and clavicles and apply high-flow oxygen. D. apply high-flow oxygen, consider spinal precautions, and transport without delay.

D

Signs and symptoms of a dislocated joint include all of the following EXCEPT: A. marked deformity. B. tenderness on palpation. C. locked joint. D. ecchymosis.

D

The MOST reliable indicator of an underlying fracture is: A. guarding. B. severe swelling. C. obvious bruising. D. point tenderness.

D

The MOST significant hazard associated with splinting is: A. aggravation of the injury or worsened pain. B. reduction in circulation distal to the injury site. C. compression of nerves, tissues, and vasculature. D. delaying transport of a critically injured patient.

D

The disruption of a joint in which the bone ends are no longer in contact is called a: A. strain. B. sprain. C. fracture. D. dislocation.

D

The zone of injury includes the: A. adjacent nerves. B. adjacent blood vessels. C. surrounding soft tissue. D. all of the above.

D

When splinting an injury of the wrist, the hand should be placed: A. into a fist. B. in a straight position. C. in an extended position. D. in a functional position.

D

Which of the following is a basic type of splint? A. Rigid B. Formable C. Traction D. All of the above

D

Which of the following is not considered one of the "6 Ps" of the musculoskeletal assessment? A. Pain B. Pulselessness C. Pressure D. Peristalsis

D

Which of the following musculoskeletal injuries would MOST likely result in deformity? A. severe strain B. moderate sprain C. hairline fracture D. displaced fracture

D

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? A. an amputated extremity B. bilateral femur fractures C. nondisplaced long bone fractures D. pelvic fracture with hypotension

D

_______ produce severe damage to the skeleton, surrounding soft tissues, and vital internal organs. A. Direct blow B. Indirect force C. Twisting force D. High-energy injury

D

Which of the following statements regarding striated muscle is correct? A. Striated muscle is involuntary because you have no conscious control over it. B. Most of the body's striated muscle is found within the walls of the blood vessels. C. Striated muscle tissue is attached directly to the bones by tough bands of cartilage. D. It forms the major muscle mass of the body and usually crosses at least one joint.

D. It forms the major muscle mass of the body and usually crosses at least one joint. Page 1087

What type of muscle contracts and relaxes to control the movement of the contents within its structures? A. cardiac B. skeletal C. striated D. smooth

D. Smooth Page 1088