Which of the following is most closely associated with calcaneal fractures?
A. Spiral fracture of the tibia
B. Compression fractures of the lumbar spine
C. Lateral compression fractures of the pelvis
A calcaneal fracture is classically caused by a fall from height onto outstretched legs, such as a parachute jump or a fall from a ladder. Thus, someone who sustains this type of fracture is likely to have other fractures that are caused by an axial load. The choice that is most likely to be caused by an axial load is a compression fracture of the lumbar spine.
What is described by the term Monteggia fracture?
A. Fracture of the proximal one-third of the ulna with associated dislocation of the radial head
B. Fracture of the mid radius with associated dislocation of the distal radial-ulnar joint
C. A distraction-type injury of the spine where the anterior ligament fails under tension
E. Disruption of the ligament binding the first metatarsal to the second
The other choices describe a Galeazzi fracture, Chance fracture, Jefferson fracture, and a Lisfranc injury, respectively.
What must be done in all posterior knee dislocations if there is no other sign of trauma?
A. Application of a long leg splint
B. Application of a long leg cast
C. Determination of compartment pressures above and below the knee
An evaluation of the popliteal artery is essential for all patients who suffer from a posterior knee dislocation to rule out occult injury to the artery. The other modalities may be helpful in selected instances, but not necessarily in every circumstance.
Which artery can be injured in a humeral shaft fracture and, if compromised, indicates operative repair of the humerus?
The radial and ulnar arteries are in the forearm and are not associated with a humeral fracture. Similarly, the subclavian artery and the aorta are not in the proximity of the humeral shaft; only the brachial artery incurs risk with a humeral shaft fracture.
Which of the following indicates nonaccidental trauma?
A. Multiple fractures in various stages of healing
B. Spiral fracture of the femur
C. Conjunctival hemorrhage
D. Alleged mechanism that does not fit the injury
E. All of the above indicate nonaccidental trauma
All of these findings can indicate a nonaccidental mechanism of injury. A high index of suspicion is necessary to correctly diagnose these injuries since misdiagnosis can have devastating effects on a child. Collaboration with child protection services is mandated by law.
Which Salter-Harris class is defined as a fracture that crosses the growth plate from the articular surface to the metaphysis?
A Salter-Harris I is a fracture through the growth plate, parallel to the joint. Salter-Harris II extends away from the joint. Salter-Harris III extends toward the joint. A type V fracture is a crush injury to the growth plate.
Which of the following is an incomplete fracture?
A greenstick fracture is seen in children due to the increased pliability of their bones. One cortex of the bone fails under tension, but the other one remains intact.
Which of the following fractures is most closely associated with intra-abdominal injuries?
B. Distal radius fractures
E. Femoral neck fractures
A Chance fracture is a failure of the anterior spinal ligament under tension. It is often caused by a seatbelt injury and there is approximately a 60% chance of an associated abdominal injury.
Which of the following is an early sign of compartment syndrome?
Paresthesia occurs early due to ischemic dysfunction of sensory nerves. Motor nerve dysfunction occurs much later. Pulselessness is a very late and very ominous sign. Piloerection is not associated with compartment syndrome.
Which of the following pelvic fracture injury patterns would be most likely following a side-impact motor vehicle accident?
A. Anterior-posterior compression (APC)
Lateral compression, which is the most common injury pattern type for pelvic fractures, occurs when a force vector is applied laterally as in this case. Open book or APC-type fractures occur with anterior to posterior vectors, whereas vertical shear injuries occur with falls onto the outstretched lower extremities. A greenstick fracture is an incomplete fracture that occurs in children.