Chapter 31: Orthopaedic Injuries

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

D

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

A subluxation occurs when

a joint is incompletely dislocated.

Common signs and symptoms of a sprain include all of the following, EXCEPT:

deformity.

Deformity caused by a fracture would MOST likely be masked by:

swelling.

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

A

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

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. assess for a carotid pulse and assist her ventilations. B. administer oxygen and perform a rapid assessment. C. apply manual stabilization to both of her femurs. D. stabilize her head and perform a primary assessment.

D

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

D. distal radius.

In moving joints, the ends of the bones are covered with:

articular cartilage.

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:

bind his legs together on the backboard, keep him warm, and transport without delay.

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

clavicle.

When assessing a patient with a possible fracture of the leg, the EMT should

compare it to the uninjured leg.

A supracondylar or intercondylar fracture is also known as a fracture of the:

distal humerus.

Assessing a person's neurovascular status following a musculoskeletal injury includes all of the following, EXCEPT:

evaluating proximal pulses.

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

femur.

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 CMS, you should

immobilize the injury with a sling and swathe.

When splinting a possible fracture of the foot, it is MOST important for the EMT to:

leave the toes exposed.

The MOST common and significant complication associated with fractures or dislocations of the knee is:

ligament and cartilage damage.

Bones are connected to other bones by bands of tough fibrous tissues called:

ligaments.

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

lumbar spine.

The MOST reliable indicator of an underlying fracture is:

point tenderness.

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

A

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

A

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

A

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

A

What is a Pneumatic Anti-Shock Garment (PASG)?

A Pneumatic Anti-Shock Garment and is sometimes referred to as MAST (Medical Anti-Shock Trouser). This is designed to provide uniform pressure on the lower extremities and abdomen. This is used in some EMS systems on shock and hemorrhage patients.

Which of the following scenarios is an example of a direct injury?

A passenger fractures her patella after it strikes the dashboard.

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

B

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

B

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

B

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

B

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

Which of the following musculoskeletal injuries would MOST likely result in deformity? A. Severe strain B. Displaced fracture C. Moderate sprain D. Hairline fracture

B

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

C

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

C

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. perform a focused physical exam with emphasis on the pelvis. B. log roll the patient onto a long backboard and transport at once. C. defer spinal immobilization and transport to a trauma center. D. stabilize the pelvis with a pelvic binder and protect the spine.

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

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

Which of the following statements regarding striated muscle is correct?

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

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:

applying padded board splints to both sides of the leg.

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

assess distal pulse, motor, and sensory functions.

Which of the following structures is regulated by smooth muscle?

blood vessels

The disruption of a joint in which the bone ends are no longer in contact is called a:

dislocation.

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:

immobilizing her to a backboard and rapidly transporting.

Crepitus and false motion are

positive indicators of a fracture.

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:

posterior hip dislocation

The primary purpose for splinting a musculoskeletal injury is to:

prevent further injury.

The PASG (Pneumatic Anti-Shock Garment) is absolutely contraindicated in patients who have:

pulmonary edema.

Applying ice to and elevating an injured extremity are performed in order to:

reduce pain and swelling.

The pectoral girdle consists of the:

scapulae and clavicles.

Which of the following types of muscle is under direct voluntary control of the brain?

skeletal

Which of the following joints allows no motion?

skull sutures

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

smooth

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

sprain

Skeletal muscle is also referred to as __________ muscle.

striated

If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting

the patient history.

The act of pulling on a body structure in the direction of its normal alignment is called:

traction.