Chapter 30- Orthopaedic Injuries
In which of the following situations would it NOT be appropriate to splint a patient's fractures before moving him or her?
Confused patient with tachycardia and shallow breathing
If your assessment of a patient with a possible musculoskeletal injury reveals no external signs of injury, it would be appropriate to:
ask the patient to move each extremity carefully.
When assessing a 14-year-old male with an injured arm, you note gross deformity just distal to the elbow. Distal neurovascular functions are grossly intact. You should:
assume that growth plate damage has occurred
General principles of splinting an injured extremity include:
frequently assessing gross neurovascular functions
The energy needed for muscular contraction is derived from the metabolism of ___________ and results in the production of:
glucose; lactic acid
Appropriate stabilization of an anterior shoulder dislocation includes:
pillow or towel under the arm and a sling and swathe.
When assessing a 40-year-old female with an injury to her left wrist, you should recall that the MOST reliable indicator of an underlying fracture is:
point tenderness
During a track and field event, a 25-year-old female sustained an injury to her left arm. She complains of severe pain and an inability to extend her elbow. Upon inspection, you note that the olecranon process is more prominent than it is on the uninjured arm. These findings are MOST characteristic of:
posterior radius/ulna displacement
A young female has a closed, unstable deformity to her left femur. In this situation, the primary reason for applying a splint is to:
prevent conversion to an open fracture
Pathologic fractures are typically caused by all of the following, EXCEPT:
previous fractures
In addition to providing the framework for the human body, bones also:
produce blood cells in the marrow.
In addition to providing the framework for the human body, bones:
produce blood cells in the marrow.
When assessing a patient with a scapular fracture, you should also be alert for:
ribs fractures and a pneumothorax.
A 21-year-old male presents with a severely angulated forearm and extreme pain. Distal sensory, motor, and circulatory functions are intact. You should:
splint the forearm in the position of deformity.
An injury that may result in complete separation of a joint due to stretching or tearing of the supporting ligaments is called a:
sprain
Joints are bathed and lubricated by:
synovial fluid
Tough, cord-like structures that are extensions of the fascia covering all skeletal muscles are known as:
tendons
A patient with developing compartment syndrome following a fracture typically complains of or presents with:
tension or pressure in the affected extremity.
When assessing a patient who has fractured his or her midshaft clavicle, you should expect to find swelling, point tenderness, and:
tenting over the fracture site.
The MOST accurate definition of a fracture is a:
a break in the continuity of a bone
During a hockey game, a 19-year-old male player was pushed and he landed on his left shoulder. He complains of pain and point tenderness to the area. Your assessment reveals an anterior bulge of the lateral clavicle. This patient has MOST likely experienced a/an:
acromioclavicular separation
In addition to 100% oxygen, appropriate management for a patient with a suspected pelvic fracture, who is conscious and alert with stable vital signs includes:
application of a pelvic binder, immobilization on a long backboard, at least one large-bore IV set to keep the vein open, and transport.
You have applied an air splint to the deformed forearm of a critically injured patient while waiting for a helicopter to arrive. When the helicopter arrives, the flight medic asks you to accompany the patient. During the flight, you should:
monitor the splint and let air out as needed.
Which of the following injuries would pose the LEAST threat to the patient?
Major sprains at a major joint
A 34-year-old male twisted his lower leg and ankle while skiing. He complains of severe pain and swelling to the area. When assessing for deformity, you should:
compare the injured extremity to the uninjured extremity.
Articular cartilage functions by:
covering the bone ends and cushioning them from damage and wear.
Following blunt force trauma to the elbow, a 40-year-old female complains of severe pain and the feeling that her elbow is "locked." Your assessment reveals marked deformity and swelling. This patient has MOST likely experienced a(n):
dislocation
Following blunt force trauma to the elbow, a 40-year-old female complains of severe pain and the feeling that her elbow is "locked". Your assessment reveals marked deformity and swelling. This patient has MOST likely experienced a/an:
dislocation.
A Colles fracture is caused by injury to the:
distal radius
Proximal humeral fractures MOST commonly occur:
elderly population
A fracture that occurs in the growth section of a child's bone, which may lead to bone growth abnormalities, is called a(n) __________________ fracture.
epiphyseal
A fracture that occurs in the growth section of a child's bone, which may lead to bone growth abnormalities, is called a/an __________________ fracture.
epiphyseal
A 70-year-old female slipped on a throw rug, but grabbed an adjacent table before she fell to the ground. When assessing her, you should recall that:
even minor mechanisms of injury can result in fractures in the elderly
A patient with a displaced fracture of the proximal femur typically presents with:
external leg rotation, with the injured leg shorter than the opposite leg.
The primary reason for applying gentle longitudinal traction to a severely angulated tibia is to:
facilitate the placement of a standard splint
Which of the following describes an injury caused by indirect force?
fall on an outstretched hand with a fractured wrist and a dislocated elbow
You have delivered your patient, a 14-year-old female with a possible femur fracture, to the emergency department. After radiographic evaluation, the physician tells you that the patient has a comminuted fracture. This means that the femur:
has fractured into more than two fragments.
In an average-sized adult male, a closed unilateral femur fracture can result in internal blood loss of up to:
1,000 mL
When using a Sager traction splint, you should apply traction that is approximately ____% of the patient's body weight to a maximum of ____ pounds.
10-15
Which of the following describes an injury caused by indirect force?
A fall on an outstretched hand with a fractured wrist and a dislocated elbow
Which of the following would be the LEAST reliable assessment parameter when determining the neurovascular status of a patient with a possible extremity fracture?
Ability to move the extremity
A 34-year-old male experienced an abduction injury to his right arm. He is found in extreme pain, holding his injured arm in a fixed position away from the chest wall. Your assessment reveals a bulge through the pectoralis major muscle and a squared off appearance of the shoulder. What has MOST likely occurred?
Anterior dislocation of the humeral head
In the process of applying a splint on a 21-year-old female with an apparent dislocated patella, the patella spontaneously returns to its normal position. You should:
immobilize her knee with a long board splint
Which of the following musculoskeletal injuries poses the GREATEST risk for compartment syndrome?
Humeral fracture in a child
Which of the following assessment findings would you expect to see in a patient with a posterior hip dislocation and sciatic nerve involvement?
Inability to dorsiflex the foot
A 50-year-old male fell approximately 20 feet and landed on his side. He is conscious and alert and denies loss of consciousness. During your assessment, you note pain and crepitus when palpating the iliac crests. In addition to the potential for spinal injury, you should be MOST concerned about:
Internal hemorrhaging
Which of the following statements regarding hip dislocations is correct?
Most hip dislocations are caused by posterior displacement of the femoral head.
When assessing a patient with multiple systems trauma, which of the following musculoskeletal injuries would pose the GREATEST threat to the patient's life?
Multiple open fractures
Which of the following statements regarding skeletal muscle is correct?
Skeletal muscle is highly vascular and bleeds significantly when injured.
Which of the following is the MOST effective method of immobilizing a fractured clavicle?
Sling and swathe
Which of the following injuries MOST accurately depicts an open fracture?
Swelling and deformity to the lateral humerus with an overlying abrasion
On which of the following injuries would it be MOST appropriate to apply a traction splint?
Swelling and ecchymosis to the midshaft femur
A major benefit of using a Sager traction splint is that it:
can be applied effectively by one AEMT if necessary.
A 29-year-old male was involved in a rollover motor-vehicle crash. The patient was removed from his vehicle prior to your arrival. During your general impression, you note that he is conscious, yelling in pain, and has an actively bleeding open fracture of his left leg. As your partner assumes manual stabilization of the patient's head and communicates with him, you should:
apply direct pressure to his leg
When assessing the pelvis of a patient with multiple systems trauma, you should:
apply gentle inward pressure to the iliac crests
When palpating an injured extremity, a patient complains of point tenderness. On the basis of this clinical finding, you:
are unable to determine the type of fracture
Decrease in the size of a muscle and its inherent ability to function is called:
atrophy
A 29-year-old male was struck in the upper back by a solid object. During your assessment, you note ecchymosis, pain, and crepitus to the left scapula. His blood pressure is 124/68 mm Hg, pulse is 110 and strong, and respirations are 24 breaths/min and labored. You should provide supplemental oxygen, immobilize his spine, and:
be alert for intrathoracic injuries
The MOST accurate definition of a fracture is a:
break in the continuity of a bone
A 55-year-old male fell from the roof of his house and sustained a closed, displaced femur fracture. He is restless, diaphoretic, and tachycardic. After appropriately managing his ABCs and performing a rapid head-to-toe assessment, you should:
immobilize him on a long backboard, transport, and start a large-bore IV en route.
A 38-year-old female sustained a high-velocity injury to her pelvis. Your assessment reveals severe pain and crepitation upon palpation of the iliac crests. Her blood pressure is 84/54 mm Hg, pulse is 120 and weak, and respirations are 26 breaths/min and unlabored. In addition to administering 100% oxygen, the MOST appropriate management should include:
immobilizing her spine, applying a pelvic binder device, transporting, and administering 20 mL/kg normal saline boluses en route.
Compartment syndrome is caused by:
increased pressure in the fascial compartment
Fractures of the proximal femur MOST commonly occur at the:
intertrochanteric region of the femur
An elderly female with a history of osteoarthritis has sustained an apparent dislocation of her left knee. She is conscious and in severe pain. Her knee is flexed and distal neurovascular functions are grossly intact. When splinting her injury, you should:
keep her knee flexed and apply board splints secured at the hip and ankle.
In addition to splinting the injured extremity, appropriate management for a patient with suspected compartment syndrome includes:
keeping the limb at the level of the heart, transporting, and frequently assessing distal pulses.
A 29-year-old male fell approximately 5 feet from a ladder and landed on his right shoulder. He is conscious and alert, denies loss of consciousness, and complains of pain to the shoulder. His vital signs are stable. You should:
manually stabilize the injury until it is splinted, perform a secondary assessment, splint the injury appropriately, and transport.
You and your partner are applying a Hare traction splint to a patient with a deformed midshaft femur. As you expose the injured femur and assess neurovascular functions, your partner should:
manually support and stabilize the injured leg.
A 34-year-old male sustained a twisting injury to his left lower leg when he stepped into a hole. Your assessment reveals ecchymosis and pain to the area, but no deformity or crepitus. You should suspect a:
nondisplaced fracture
A 59-year-old male patient impacted the dashboard with his knees when his car struck a tree at 50 mph. During your primary assessment, you note bleeding from an obvious open femur fracture. After controlling the bleeding, applying oxygen, and extricating him from the car, you should:
perform a head-to-toe assessment, immobilize his spine, and transport.
An 80-year-old male tripped and fell and complains of pain to his left hip. Your assessment reveals that his knee is flexed and his left leg is shortened and medially rotated. Distal neurovascular functions are grossly intact. You should immobilize this patient's injury by:
placing him on a scoop stretcher and padding the injury with pillows.
Goals of in-line traction for musculoskeletal injuries in the prehospital setting include all of the following, EXCEPT:
reduction of the fracture.
Which of the following muscles is attached to the skeleton and forms the bulk of tissue of the arms and legs?
skeletal
___________ muscle is a component of body systems, including the digestive and cardiovascular systems.
smooth
A 30-year-old male fell while rollerblading and landed on his right arm. There is obvious deformity to the elbow and the patient complains of severe pain. The patient's hand is cool and pale and his radial pulse is difficult to palpate. The hospital is approximately 10 minutes away. You should:
splint the arm in the position found and then transport immediately.
You arrive at the scene of a motor vehicle crash in which a 30-year-old male was ejected from his truck. As you approach the patient, who is not moving, you can see that he has gross deformity to both of his femurs and an angulated left humerus. You should:
stabilize his head and open his airway.
You arrive at the scene of a motor-vehicle crash in which a 30-year-old male was ejected from his truck. As you approach the patient, who is not moving, you can see that he has gross deformity to both of his femurs and an angulated left humerus. You should:
stabilize his head and open his airway.
To align a severe deformity associated with a humeral shaft fracture, you should:
support the fracture site with one hand and apply gentle traction by grasping the humeral condyles.
When assessing a patient with a grossly deformed humerus, you note that the radial pulse is absent and the extremity is becoming cyanotic. You should:
use constant, gentle manual traction to align the humerus.
