Chapter 31: Orthopaedic Injuries

Spiral fracture

A fracture caused by twisting or spinning force, causing a long, spiral-shaped break in the bone. This is sometimes the result of abuse in young children.

Oblique fracture

A fracture in which the bone is broken at an angle across the bone. This is usually the result of a sharp, angled blow to the bone.

Comminuted fracture

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

Pathologic fracture

A fracture of weakened or diseased bone, seen in patients with osteoporosis, infection, or cancer; often produced by minimal force

Incomplete fracture

A fracture that does not run completely through the bone; a nondisplaced partial crack

Epiphyseal fracture

A fracture that occurs in a growth section of a child's bone and may lead to growth abnormalities

Transverse fracture

A fracture that occurs straight across the bone. This is usually the result of a direct blow injury

A disruption of a joint in which the bone ends are no longer in contact is known as what? A. Dislocation B. Fracture C. Sprain D. Strain

A. Dislocation That's Correct! A dislocation is a disruption of a joint in which the bone ends are no longer in contact.

You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury? A. Splint from the shoulder joint to the wrist joint to stabilise the entire arm. B. Apply a Sager traction splint to stabilize the joint. C. Apply a sling and swathe to reduce pain. D. Apply ice to reduce swelling.

A. Splint from the shoulder joint to the wrist joint to stabilise the entire arm. That's Correct! When splinting a fracture in and around a joint, be sure to stabilize the bones above and below the injured joint.

Which of the following is a drawback of an air splint? A. Temperature changes affect air pressure in the splint. B. It does not provide uniform contact, so bone movement is possible. C. It restricts distal blood flow. D. It is complicated to use and requires multiple EMTs.

A. Temperature changes affect air pressure in the splint. That's Correct! A drawback of an air splint is that temperature or altitude changes affect the air pressure in the splint.

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. a passenger fractures her patella after it strikes the dashboard

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: Select one: 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. apply gentle manual traction in line with the limb and reassess for a pulse.

Which of the following statements regarding compartment syndrome is MOST correct? A. compartment syndrome typically develops within 6 to 12 hours after an injury B. It most commonly occurs following a pelvic fracture C. It is caused by elevated pressure within the bone cavity D. It most commonly develops within minutes of the injury

A. compartment syndrome typically develops within 6 to 12 hours after an injury

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. nondisplaced pelvic fracture

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

A. prevent further injury

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

A. scapulae and clavicles

A 31-year-old male fell and landed on is left elbow. Your assessment reveals that the elbow is grossly deformed, his forearm is cool and pale, and the distal pulse is barely palpable. His vital signs are stable and he denies any other injuries. Your transport time to the closet appropriate hospital is approximately 12 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. splint the elbow in the position found and transport

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

A. stabilise her head and perform a primary assessment.

Greenstick fracture

An incomplete fracture that passes only partway through the shaft of the bone but may still cause substantial angulation; occurs in children.

What is the primary goal of in-line traction? A. Minimize pain B. Avoid further neurovascular compromise C. Reduce swelling D. Prevent permanent disability

B. Avoid further neurovascular compromise That's Correct! The goal of in-line traction is to avoid further neurovascular compromise.

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

B. If resistance is encountered or the patient experiences severe pain

Which MOI causes a fracture or dislocation at a distant point? A. Direct blow B. Indirect force C Twisting force D. High-impact injury

B. Indirect force That's Correct! An indirect force is more likely to cause a fracture or dislocation at a distant point.

In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel? A. Moderate B. Serious C. Severe D. Critical

B. Serious That's Correct! A laceration of a major nerve or blood vessel is considered a serious injury.

A fracture is MOST accurately defined as a: 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. break in the continuity of the bone

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. compare it to the uninjured leg.

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

B. distal humerus.

During your 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 stabilisation of her head. The MOST appropriate treatment for this patient includes: A. splinting her femur fracture with padded board splints. B. immobilising her to a backboard and rapidly transporting C. applying a traction splint to immobilise her femur D. carefully splinting each of her deformed extremities

B. immobilising her to a backboard and rapidly transporting

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. leave the toes exposed

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

B. positive indicators of a fracture.

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

B. pulmonary edema

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. reduce pain and swelling

A __________ is a musculoskeletal injury in which there is a 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. sprain

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

B. tendons.

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

B. the patient is clinically unstable.

Which of the following structures is regulated by smooth muscle? A. Heart B. Skeleton C. Blood vessels D. Diaphragm

C. Blood vessels

Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome? A. Referred pain B. Limb deformity C. Disproportionate pain D. Hypersensation

C. Disproportionate pain That's Correct! Disproportionate pain on passive stretch of muscles within the compartment is a sign of compartment syndrome.

Which of the following fractures has the greatest potential for internal blood loss and shock? A. Hip B. Femur C. Pelvis D. Humerus

C. Pelvis

When assessing distal circulation in a patient's lower extremities, which pulse should you palpate? A. Femoral B. Dorsalis pedis C. Popliteal D. Iliac

C. Popliteal That's Correct! You would palpate the popliteal artery in lower extremity wounds.

Which of the following would you use to stabilize an AC separation? A. Zippered air splint B. Rigid splint C. Sling and swathe D. Traction splint

C. Sling and swathe That's Correct! An AC separation occurs in the shoulder and so using a sling and swathe is an effective way to splint the injury.

A construction worker's arm was severed just above the elbow when a steel girder fell on it. The stump is covered with a blood-soaked towel The patient's skin is cool, clammy, and pale. The EMT should: A. administer high-flow oxygen to the patient B. remove the towel and inspect the wound C. apply a tourniquet just below the shoulder D. wrap the severed arm in a sterile dressing

C. apply a tourniquet just below the shoulder

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 function are intact. You should: A. apply a traction splint to realign the deformity B. flex the knee slightly and apply a formable splint C. apply padded board splints to both sides of the leg D. bind the legs together and elevate them 6 to 8 inches.

C. apply padded board splints to both sides of the leg

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. area of soft-tissue damage surrounding the injury

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 out air as necessary D. remove the air splint and reimmobilise with padded board splints

C. assess the amount of air in the splint and let out air as necessary

A 17-year-old football player collided with another player and has pain to his left clavicle. 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. immobilise the injury with a sling and swathe D. place a pillow under his arm and apply a sling

C. immobilise the injury with a sling and swathe

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

C. keep her knee flexed and secure it with padded board splints.

Which of the following statements regarding shoulder dislocations is 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. most shoulder dislocations occur anteriorly

A 30-year-old man complains of severe pain to this right tibia following an injury that occurred the day before. The patient's leg is pale and he is unable to move his foot. The EMT should suspect that: A. the nerves behind the knee are compromised B. a severe infection has developed in the muscle C. pressure in the fascial compartment is elevated. D. the nerves supplying the foot have been severed.

C. pressure in the fascial compartment is elevated.

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

C. stabilise the pelvis with a pelvic binder and protect the spine.

Passengers who are seated in the rear of a vehicle and are wearing only lap belts have a higher incidence of injuries to the: Choose one answer. A. thoracic and sacral spine. B. lumbar and coccygeal spine. C. thoracic and lumbar spine. D. lumbar and sacral spine.

C. thoracic and lumbar spine.

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. Pelvic fracture with hypotension

The Most reliable indicator of an underlying fracture is: A. Guarding B. Severe swelling C. Obvious bruising D. Point tenderness

D. Point tenderness

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 stabilise 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. control the bleeding and cover the wound with a sterile dressing

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

D. delaying transport of a critically injured patient.

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

D. pathologic

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

D. proximal femur

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

D. the overlying skin is no longer intact.

A subluxation occurs when: a) a joint is incompletely dislocated. b) a fracture and a dislocation exist. c) a bone develops a hairline fracture. d) ligaments are partially severed.

a) a joint is incompletely dislocated.

Bones are connected to other bones by bands of tough fibrous tissues called: a) ligaments. b) tendons. c) bursa. d) cartilage.

a) ligaments.

The MOST common and significant complication associated with fractures or dislocations of the knee is: a) neurovascular compromise. b) total depletion of synovial fluid. c) ligament and cartilage damage. d) internal bleeding and shock.

a) neurovascular compromise.

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 because of disease or trauma. c) the tendons that attach muscle to bone become stretched or injured. d) increased use of skeletal muscle causes an increase in its strength.

b) muscle decreases in size and function because of disease or trauma.

The MOST commonly fractured bone(s) in the body is the: a) radius and ulna. b) scapula. c) clavicle. d) midshaft femur.

c) clavicle.

Which of the following musculoskeletal injuries would MOST likely result in deformity? a) moderate sprain b) severe strain c) displaced fracture d) hairline fracture

c) displaced fracture

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

When splinting an injury of the wrist, the hand should be placed: a) into a fist. b) in a straight position. c) in a functional position. d) in an extended position.

c) in a functional position.

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) a thoracic spine fracture. b) anterior hip dislocation. c) posterior hip dislocation. d) fracture of the tibia or fibula.

c) posterior hip dislocation.

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) splint each of his deformed femurs with long board splints and transport immediately. b) apply the MAST to stabilize his femurs and transport at once. c) apply traction splints to both of his legs, keep him warm, and transport without delay. d) bind his legs together on the backboard, keep him warm, and transport without delay.

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