Fracture Management

Chapter 169 Fracture Management




Clinical Case Problem 1: A 75-Year-Old Woman Who Slipped and Fell on Her Outstretched Hand


A 75-year-old woman is brought to the emergency department after having fallen on her outstretched hand. She complains of pain in the area of the right wrist.


On examination, there is a deformity in the area of the right wrist. The wrist has the appearance of a dinner fork. There is significant tenderness over the distal radius. Both the pulse and sensation distal to the injury are completely normal.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. fracture of the distal ulna with dislocation of the radial head

b. fracture of the carpal scaphoid

c. fracture of the carpal lunate

d. Colles fracture

e. fracture of the shaft of the radius with dislocation of the ulnar head

2. What is the treatment of choice for this patient?


a. internal reduction and immobilization

b. internal reduction and fixation

c. external reduction and immobilization

d. external reduction and fixation

e. none of the above


Clinical Case Problem 2: The Team’s Top Scorer Fell and Hurt His Hand


An 18-year-old basketball player is brought to the emergency department after having fallen on his outstretched hand. He is the league’s leading scorer, and his coach directs you to “fix it and fix it fast.”


On examination, there is slight tenderness and swelling just distal to the radius, in the snuffbox. No other abnormalities are found. Radiographs of the wrist and hand are normal.






3. What is the most likely diagnosis in this patient?


a. second-degree wrist sprain

b. avulsion fracture of the distal radius

c. fractured scaphoid

d. fractured triquetrum

e. none of the above

4. What is the treatment of choice for this patient?


a. active physiotherapy

b. passive physiotherapy

c. nonsteroidal antiinflammatory drugs

d. surgical exploration of the wrist

e. none of the above

5. What is the major complication of the injury described in this case?


a. peripheral nerve injury

b. local muscle damage

c. peripheral arterial injury

d. avascular necrosis of the bone

e. septic arthritis of the joint


Clinical Case Problem 3: A 25-Year-Old Man with Pain in His Ankle


A 25-year-old man is brought to the emergency department after having been thrown from his motorcycle. He complains of severe pain in the area of the right ankle and is unable to bear weight on the foot.


On examination, there is swelling of the entire right ankle, with more prominent swelling on the lateral side. There is point tenderness over the lateral malleolus. There does not appear to be any other deformity or abnormality.



6. What is the most likely diagnosis in this patient?


a. second-degree ankle sprain

b. third-degree ankle sprain

c. fractured distal tibia

d. fractured distal fibula

e. fractured talus

7. What is the treatment of choice for this patient?


a. internal reduction and fixation

b. external reduction and fixation

c. active physiotherapy

d. ice, compression, and elevation

e. immobilization of the ankle

8. Which of the following statements regarding acute compartment syndrome is (are) true?


a. acute compartment syndrome is caused by increasing pressure within a closed fascial space as a result of effects of the injury

b. acute compartment syndrome is found primarily in the lower leg and the forearm

c. acute compartment syndrome may lead to muscle and nerve ischemia

d. acute compartment syndrome may lead to muscle and nerve death

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Fracture Management

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