Chapter 31 Orthopaedic Injuries

Oblique

(adj.) slanting or sloping; not straightforward or direct

Suspect a fracture if one or more of the following signs are present:

. Deformity b. Tenderness c. Guarding d. Swelling e. Bruising f. Crepitus g. False motion h. Exposed fragments i. Pain j. Locked joint

There is often a significant amount of blood loss, as much as 500 to _________mL, after a fracture of the shaft of the femur.

1,000

treating Strains and sprains

1. Treat every severe sprain as if it is a fracture. 2. General treatment is similar to that of fractures and includes RICES: a. Rest b. Ice c. Compression d. Elevation e. Splinting

Transverse

: A fracture that occurs straight across the bone

Strain

A condition resulting from damaging a muscle or tendon

Bone marrow produces: A) blood cells B) lymphocytes C) cartilage D) electrolytes

A) blood cells

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

A) deformity

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

A) delaying transport of a critically injured patient

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

A) distal radius

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

A) ecchymosis

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

A) if resistance is encountered or the patient experiences severe pain

Improperly applying a splint can cause all of the following, EXCEPT: A) increase of distal circulation if the splint is to tight B) aggravation of the distal circulation C) delay in transport of a patient with a life-threatening injury D) compression of nerves, tissues, and blood vessels

A) increase of distal circulation if the splint is to tight

A 17-year-old female dislocated her patella while playing soccer. Her knee is flexed and she complains of severe pain. You should: A) keep her knee flexed and secure it with padded board splints B) gently straighten her knee and apply a padded board splint C) make one attempt to return the patella to its normal position D) flex her knee slightly more and assess for distal circulation

A) keep her knee flexed and secure it with padded board splints

Care for a patient with a fractured tibia and suspected compartment syndrome includes: A) keeping the leg at the level of the heart B) applying traction to maintain distal pulses C) applying chemical hot packs to the leg D) immobilizing the leg with an air splint

A) keeping the leg at the level of the heart

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) lumbar spine B) thoracic spine C) coccygeal spine D) symphysis pubis

A) lumbar spine

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

A) pathologic

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

A) pelvic fracture with hypotension

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) place her onto a scoup stretcher, pad around her left hip with pillows, and secure her to the scoop stretcher B) bind both of her legs together with triangular bandages and carefully secure her onto the aombulance stretcher C) manually stabilize her left leg, apply a traction splint, and then secure her to a long backboard or scoop D) carefully slide a long backboard underneath her, keep her in a supine position, and apply a splint to her leg

A) place her onto a scoup stretcher, pad around her left hip with pillows, and secure her to the scoop stretcher

PLAY A 20-year-old male collided with another player during a hockey game and complains of severe pain to the left shoulder. Assessment reveals that the clavicle is bulging anteriorly at the shoulder. The EMT should suspect: separation of the acromioclavicular joint 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) posterior hip dislocation B) a thoracic spine fracture C) fracture of the tibia or fibula D) anterior hip dislocation

A) posterior hip dislocation

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

A) proximal femur

A 20-year-old male collided with another player during a hockey game and complains of severe pain to the left shoulder. Assessment reveals that the clavicle is bulging anteriorly at the shoulder. The EMT should suspect: A) seperation of the acromioclavicular joint B) multiple fractures of the proximal humerus C) dislocation of the glenohumeral joint D) posterior dislocation of the shoulder

A) seperation of the acromioclavicular joint

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

A) tendons

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

A) the patient is clinically unstable

Amputations

An amputation is an injury in which an extremity is completely severed from the body.

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

B) bones and voluntary muscles of the body

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

B) carefully assess the patient for breathing problems

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

B) compartment syndrome typically develops within 6 to 12 hours after an iinjury

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

B) hematuria

Because of local tenderness and swelling, it is easy to confuse a nondisplaced or minimally displaced fracture of the knee with a: A) dislocation B) ligament injury C) tendon injury D) fracture-dislocation

B) ligament injury

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

B) muscle decreases in size and function

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

B) traction

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 BVM and monitor his oxygen saturation B) focus your assessment on his scapulae and clavicles and apply high-flow-oxygen C) apply high-flow oxygen, consider spinal precautions, and transport without delay D) apply high-flow exygen, perform a detailed secondary assessment, and transport

C) apply high-flow oxygen, consider spinal precautions, and transport without delay

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

C) break in the continuity of the bone

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

C) displaced fracture

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

C) distal humerus

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

C) epiphyseal

Which of the following statements about compartment syndrome is NOT true? A) it is usually a result of excessive bleeding, a severity crushed extremity, or the rapid return of blood to an ischemic limb B) it is characterized by pain that is out of proportion to the injury C) it most commonly occurs with a fractured femur D) it occurs 6 to 12 hours after an injury

C) it most commonly occurs with a fractured femur

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

C) ligaments

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

C) neurovascular compromise

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) stabilize her head and perform a primary assessment D) assess for a cartoid pulse and assist her ventilations

C) stabilize her head and perform a primary assessment

During your secondary assessment of a 30-year-old male who fell 25 feet, 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) stabilize the pelvis with a pelvic binder and protect the spine

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

C) swelling

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

C) the patient history

compartment syndrome

Compartment syndrome typically develops within 6 to 12 hours after injury, usual as a result of:involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles

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

D) 1,000

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) make two or three attempts to restore distal circulation by manipulating the elbow B) carefully straighten the injured arm and secure it with padded board splints C) splint the elbow in the position of deformity and transport immediately D) apply gentle manual traction in line with the limb and reassess for a pulse

D) apply gentle manual traction in line with the limb and reassess for a pulse

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

D) area of soft-tissue damage surrounding the injury

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

D) articular cartilage

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) gently manipulate the injured leg until the numbness dissipates C) manually stabilize the leg above and below the site of injury D) control the bleeding and cover the wound with a sterile dressing

D) control the bleeding and cover the wound with a sterile dressing

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

D) positive indicators of a fracture

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

D) the overlying skin is no longer intact

Traction splints

Designed to stabilize femur fractures. Do not use if hip appears to be dislocated.

smooth muscle

Involuntary muscle found inside many internal organs of the body

Formable splints

The most commonly used formable or soft splint is the precontoured, inflatable, clear plastic air splint. b. Always inflate the splint after applying it. c. The air splint is comfortable, provides uniform contact, and has the added advantage of applying firm pressure to a bleeding wound. d. Air splints are used to stabilize injuries below the elbow or below the knee. e. Air splints have some drawbacks, particularly in cold weather areas. i. The zipper can stick, clog with dirt, or freeze. ii. Significant changes in the weather or altitude affect the pressure of the air in the splint. f. For a splint that has a zipper, follow the steps in Skill Drill 31-3.

Epiphyseal

a break at the location of the growth plate, which can affect growth of the bone

The signs and symptoms of a dislocated joint are similar to those of a fracture.

a. Marked deformity b. Swelling c. Pain that is aggravated by any attempt at movement d. Tenderness on palpation e. Virtually complete loss of normal join motion (locked joint) f. Numbness or impaired circulation to the limb or digit

You can help reduce the risk or duration of long-term disability by:

a. Preventing further injury b. Reducing the risk of wound infection c. Minimizing pain by the use of cold and analgesia d. Transporting patients to an appropriate medical facility

The likelihood of having a complication is often related to the

a. Strength of the force that caused the injury b. Injury's location c. Patient's overall health

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:

bleeding

The bones in the skeleton produce _________ in the bone marrow.

blood cells

Rigid splints

boards, metal strips, folded magazines.

Greenstick

bone breaks incompletely

Comminuted

bone breaks into many fragments

displaced fracture

bone ends are out of normal alignment

Incomplete

bone is not broken all the way through

closed fracture

broken bone with no open wound

The MOST commonly fractured bone(s) in the body is/are the

clavicle

The _________ is one of the most commonly fractured bones in the body.

clavicle

A _____ fracture is a fracture in which the bone is broken into more than two fragments.

comminuted

open fracture

compound fracture; broken bone with an open wound

A fracture is a break in the _______ of the bone

continuity

A grating or grinding sensation known as ________ can be felt, and sometimes even heard, when fractured bone ends rub together.

crepitus

A _____ fractures the bone at the point of impact

direct blow

______ is a disruption of a joint in which the bone ends are no longer in contact

dislocation

A ____ produces actual deformity, or distortion, of the limb by shortening, rotating, or angulating it

displaced fracture

dislocation

displacement of a bone from its joint

Fractures are almost always associated with ____ of the surrounding soft tissue

ecchymosis

Traction splints are used primarily to immobilize and secure fractures of the:

femur

Pathologic

fracture caused by diseased or weakened bone

_____ produce severe damage to the skeleton, surrounding soft tissues, and vital internal organs.

high-energy injuries

When splinting an injury of the wrist, the hand should be placed:

in a functional position

An _____ may cause a fracture or dislocation at a distant point

indirect blow

A sprain

injury to a ligament

______ are held together in a tough fibrous structure known as a capsule

joints

The knee is especially susceptible to ____ injuries, which occur when abnormal bending or twisting forces are applied to the joint.

ligament

A _____ is also known as a hairline fracture

non-displaced fracture

Regardless of the extent and severity of the damage to the skin, you should treat any injury that breaks the skin as possible

open fracture

You are called to the local assisted living facility where a 94 year old man has fallen. He states that he was walking, heard a pop, and fell to the floor. You suspect a ____ fracture

pathologic

An _____ may cause a fracture or dislocation at a distant point indirect blow When caring for patients who have fallen, you must identify the _____ and the mechanism of injury so that you will not overlook associated injuries.

point of contact

Spiral

ragged break occurs when excessive twisting forces are applied to a bone

striated muscle

skeletal muscle

What type of muscle contracts and relaxes to control the movement of the contents within its structures?

smooth

A ____ is an injury to the ligaments, the articular capsule, the synovial membrane, and the tendons crossing the joint

sprain

A ____ is a stretching or tearing of the muscle

strain

Skeletal muscle

striated and voluntary Also called striated muscle because of its characteristic stripes; attaches to the bones and usually crosses at least one joint. a. Called voluntary muscle because it is under direct voluntary control of the brain, responding to commands to move specific body parts b. Skeletal muscle makes up the largest portion of the body's muscle mass. c. All skeletal muscles are supplied with arteries, veins, and nerves. d. Skeletal muscle tissue is directly attached to the bone by tendons. 2. Smooth muscle (involuntary muscle) performs much of the automatic work of the body. a. Cardiac muscle is a specially adapted involuntary muscle with its own regulatory system.

Joints are bathed and lubricated by _________ fluid.

synovial

You respond to a 19 year old woman who was kicked in the leg by a horse. You should compare the limb to

the opposite uninjured limb

Smooth muscle is found in the

walls of blood vessels