Ortho. ~ Short Answer

Question 1.

A 27 year old motorcyclist sustains an isolated injury to his left wrist in a motor vehicle accident.

Ortho Xray 1 Short Answer

A.) Describe the abnormalities seen in the x-ray

Show Answer

  • AP
    • Abnormal alignment of lunate relative to other carpal bones – “piece of pie” sign
    • Fractured ulna styloid
  • Lateral
    • Lunate has lost articulation with radius and capitate
    • Capitate displaced dorsally
    • “spilled tea cup” sign

(3 marks)

B.) What is the diagnosis?

Show Answer

  • Lunate dislocation
  • Fractured ulna styloid
  • Closed injury

(3 marks)

C.) What is the most important acute complication of this injury?

Show Answer

  • Median nerve compression

(1 mark)

D.) List 3 long term complications of this injury

Show Answer

  • Carpal instability leading to degenerative arthritis
  • Delayed union
  • Malunion
  • Non-union
  • Avascular necrosis

(3 marks)

Author: J Haire

Ref: Tintinalli p. 1812-13


 

Question 2.

This 45 year old man presented following a fall from a ladder. He has suffered an injury to his right arm.

 

 Ortho Xray 2 Short Answer

A.) Describe the injuries shown in this x-ray

Show Answer

  • Posterior dislocation of the elbow
  • Likely displaced laterally; need AP view to confirm
  • Intra-articular bone fragments – likely coronoid process fracture

(2 marks)

B.) What are the acute complications for this injury that should be sought on initial examination?

Show Answer

  • Neurovascular status – these structures may be entrapped
    • Brachial
    • Ulnar N
    • Median N
    • Radial N

(4 marks)

C.) How would you reduce this?

Show Answer

  • Procedural sedation
  • Longitudinal traction on wrist and forearm with assistant applying counter-traction on the upper arm
  • At same time correct medial or lateral displacement
  • Apply down-ward pressure on the proximal forearm to disengage the coronoid process from the olecranon fossa
  • Reassess neurovascular state
  • Check full ROM and instability
  • Long arm slab
  • Check x-ray

(6 marks)

D.) What will you check for in the post-reduction x-ray?

Show Answer

  • medial epicondyle entrapment
  • intra-articular fragments

(2 marks)

E.) What mandates orthopaedic admission?

Show Answer

  • Neurovascular compromise
  • Inability to reduce closed
  • Other fractures
  • Instability post-reduction
  • Open dislocations

(3 marks)

F.) What are the potential late complications?

Show Answer

  • Post-traumatic stiffness
  • Posterolateral joint instability
  • Ectopic ossification
  • Occult distal radioulnar joint disruption

(2 marks)

Author: J Haire

Ref: Tintinalli p. 1824-25


 

Question 3.

A 38 year old woman presents with severe pain in her right foot after a fall from her motorcycle 2hours earlier. She has no other injuries.

AP

 Ortho Xray 3 Short Answer

Lateral

Ortho Xray 4 Short Answer

A.) Describe the abnormalities seen in the x-rays

Show Answer

  • AP
    • Lateral displacement of the 2nd metatarsal from 1st metatarsal > 1mm
    • Avulsion fracture 2nd metatarsal
    • Lateral displacement of 3rd metatarsal too
  • Lateral
    • No dorsal/plantar misalignment seen

(3 marks)

B.) What is the diagnosis?

Show Answer

  • Lis Franc fracture/dislocation

(1 mark)

C.) What has been disrupted?

Show Answer

  • Disruption of the Lis Franc ligament

(1 mark)

D.) What further imaging could you obtain?

Show Answer

  • CT

(1 mark)

E.) What is the definitive management?

Show Answer

  • Reduction in OT by orthopaedics

(1 mark)

F.) What is the acute complication of this type of injury?

Show Answer

  • Compartment syndrome

(1 marks)

Author: J Haire

Ref: Tintinalli p. 1876-77


 

Question 4.

A 65 year old woman has been brought to your emergency department after being struck by a car at a pedestrian crossing. She has a painful right leg. Her AP and Lateral X-rays are shown

Ortho Xray 5 Short Answer Ortho xray 6 Short Answer (Error) 1

 

A.) Describe the bony injuries in these x-rays

Show Answer

  • AP
    • Transverse fracture through proximal tibia (metaphysis); no displacement; no separation; no rotation
    • Comminuted & transverse fracture through proximal fibula (metaphysis); 1 mm separation and lateral displacement
  • Lateral
    • Transverse fracture through the proximal tibia (metaphysis)
    • Impacted
    • Distal fragment displaced 2 mm plantar direction (slight displacement)
    • Distal fragment angulated 30° plantar

(6 marks)

B.) What other abnormalities can be seen on the x-rays?

Show Answer

  • Calcification vessels posterior distal femur
  • 2 round lucencies in proximal tibia; holes from previous plates?
  • Splint/bandage

(3 marks)

C.) What are the acute complications that could arise from this injury?

Show Answer

  • Common peroneal nerve injury
  • Popliteal artery injury
  • Compartment syndrome

(2 marks)

D.) What are the late complications that could arise from this injury?

Show Answer

  • Non-union
  • Malunion
  • Traumatic arthritis
  • Reflex sympathetic dystrophy
  • Loss of function

(3 marks)

 Author: J Haire

 

Ref:  Tintinalli p. 1787-89; 1795; 1865


 

 

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