Ambulatory Injuries Flashcards Preview

MD2 Ambulatory Care and Emergency Medicine > Ambulatory Injuries > Flashcards

Flashcards in Ambulatory Injuries Deck (15)
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1
Q

What are the potential complications of an off-ended, closed clavicle fracture?

A

Peripheral neurovascular complications
May not heal (non-union) > pain and loss of function
Mal-union

2
Q

What is the management of an off-ended, closed clavicle fracture?

A
Early
- Splint > sling
- Adequate analgesia
Definitive
- Surgical fixation
3
Q

What are the Ottawa ankle rules?

A

Ankle x-ray needed if pain in malleolar zone AND any of
- Bone tenderness at posterior edge/tip of lateral malleolus
- Bone tenderness at posterior edge/top of medial malleolus
- Inability to bear weight both immediately after injury and in ED
Foot x-ray only needed if pain in malleolar zone AND one of
- Bone tenderness at base of 5th metatarsal
- Bone tenderness at navicular
- Inability to bear weight both immediately after injury and in ED

4
Q

What is the initial management of the sprained ankle?

A

RICE
- R = rest
- I = ice
- C = compression > also splinting > sometimes need plaster if too sore
- E = elevation
Analgesia
If improving, continue with their activity level
May need physiotherapy to strengthen muscles of ankles, and proprioceptive exercise

5
Q

What is the commonest carpal bone to fracture?

A

Scaphoid

6
Q

What commonly causes a scaphoid fracture?

A

Fall on outstretched hands > axial and rotation

7
Q

What other fractures are common with a fall on outstretched hands?

A

Radius fracture

Lunate dislocation > scapho-lunate ligament disruption

8
Q

What are the major complications of a scaphoid fracture?

A

Avascular necrosis
- Proximal scaphoid most in danger
- Because of retrograde blood supply
Intra-articular fracture > joint fluid effusion > washes away fracture haematoma

9
Q

What other bones are prone to avascular necrosis?

A

Lunate
Head of femur
Talus
Naviculum

10
Q

What are the clinical features of scaphoid fractures?

A

Tenderness
Paraesthesia in distribution of median nerve
Swelling

11
Q

What would you do if the clinical features of a fracture are present but the x-ray does not show a fracture?

A
Splint suspected area and sling
Analgesia
Rest
Come back in a week for another x-ray
If still doesn't show, can do MRI = gold standard
12
Q

What is the classical presentation of an Achilles tendon rupture?

A

Very painful ankle
Medial malleolus pressing on overlying skin > very pale
Heel drawn up
Foot plantar flexed
Significant bruising and swelling > bones intact

13
Q

What is the immediate management of a dislocated ankle?

A
Analgesia/anaesthesia
Reduce dislocated joint ASAP
Splinting
Further imaging to confirm reduction
Referral for further management
14
Q

How do you decide whether an ankle fracture requires operative management?

A
Absolute indication (for any fracture)
- Open fracture
- Neovascular compromise
Relative indication
- Talar shift >5 mm
- Fracture moved a certain amount
- Irregular/incongruent joint space
- Intra-articular fracture
15
Q

What is the Canadian C-spine rule?

A
Any high risk factors mandating radiography?
- >65 years
- Fall from >1 m/5 stairs
- Axial load
- MVA >100 km/hr, rollover or ejection from vehicle
- MVA involving recreational vehicle
- Bicycle collision
If yes > imaging
If no > any low risk factor allowing safe range of motion assessment?
- Simple rear-end MVA
- Sitting position in ED
- Ambulatory at any time
- Delayed onset of neck pain
- Absence of midline cervical spine tenderness
If no > imaging
If yes > able to actively rotate neck?
- 45 degrees to left and right
If no > imaging
If yes > no imaging needed