Chapter 269-272 BY Sameh sejiney MD.

Chapter BY Sameh sejiney MD

16 year old male fall on outstretched hand, on examination he holds the elbow in 45 degrees of flexion. The olecranon is directed posteriorly, radiographic image confirm posterior dislocation of the elbow. The most frequently neurovascular injury occurred with this dislocation Brachial artery disruption. Radial nerve. Ulnar nerve injury. Medial nerve injury. Compartment syndrome.

Middle age male post FOOSH complain of palmer paresthesias and dorsiflexion deformity of the writs. Radiographic reveal distal metaphyseal fracture of the radius. Lateral view shows dorsal angulation. This type of injury called. Smith fracture. Colles fracture. Barton fracture. Galeazzi fracture-dislocation.

Middle age male post FOOSH complain of palmer paresthesias and dorsiflexion deformity of the writs. Radiographic reveal distal metaphyseal fracture of the radius. Lateral view shows dorsal angulation. This type of injury called. Smith fracture. Colles fracture. Barton fracture. Galleazzi fracture-dislocation

Middle age male FOOSH. on Examination generalized wrist pain, swelling and tenderness. Radiographic , PA view shows “ piece-of-pie” sign and in lateral view shows “ spilled teacup” sign. Next step in management Thumb spica. Emergency orthopedic consultation. Ulnar gutter cast. Radial gutter cast.

Emergency orthopedic consultation.
Middle age male FOOSH. on Examination generalized wrist pain, swelling and tenderness. Radiographic , PA view shows “ piece-of-pie” sign and in lateral view shows “ spilled teacup” sign. Next step in management Thumb spica. Emergency orthopedic consultation. Ulnar gutter cast. Radial gutter cast.

Which one of the following fracture, treatment with volar splint is acceptable.
Scaphoid fracture. Lunat fracture. Capitate fracture. Triquetrum fracture. Trapezium fracture.

Meddle age male FOOSH complain of pain and swelling on the radial side of the wrist. Examination reveals localized tenderness on the dorsum of the wrist and clicking sensation with wrist movement. Radiographic PA view shows “cortical ring sign” of scaphoid and lateral view shows characteristic zigzag pattern with lunat tilt dorsally. This type of injury if left untreated complicated with: Sever degenerative arthritis. Avascular necrosis. Malunion. nonunion.

Sever degenerative arthritis.
Meddle age male FOOSH complain of pain and swelling on the radial side of the wrist. Examination reveals localized tenderness on the dorsum of the wrist and clicking sensation with wrist movement. Radiographic PA view shows “cortical ring sign” of scaphoid and lateral view shows characteristic zigzag pattern with lunat tilt dorsally. This type of injury if left untreated complicated with: Sever degenerative arthritis. Avascular necrosis. Malunion. nonunion.

Which of the following is true regarding scaphoid fracture.
More distal of the fracture greater the risk of developing avascular necrosis. Two-thirds of the fracture occur at proximal third Splinting in palm flexion and ulnar deviation help to reduce the fracture segment. More proximal of the fracture greater the risk of developing avascular necrosis.

Meddle age man fall on outstretched hand with impact on the thenar eminence, he complain of pain and swelling on radial side of the wrist and clicking sensation with movement, on radiographic AP view shows Terry Tomas sign. This patient had Fracture of lunat Dorsal intercalated segment instability Scapholunate dissociation Scaphoid linear nondisplaced fracture

Scapholunate dissociation
Meddle age man fall on outstretched hand with impact on the thenar eminence, he complain of pain and swelling on radial side of the wrist and clicking sensation with movement, on radiographic AP view shows Terry tomas sign. This patient had Fracture of lunat Dorsal intercalated segment instability Scapholunate dissociation Scaphoid linear nondisplaced fracture

Regarding FOOSH, which of the following the most common carpal bone fracture
Lunate Scaphoid Capitate hamate

Regarding FOOSH, which one of the following most common carpal bone dislocation
Lunate Scaphoid Capitate hamate

Lunate Regarding FOOSH, what the most common carpal bone dislocation
Scaphoid Capitate hamate

FOOSH with impact on hypothenar eminence complain of pain and swelling on ulnar side. Examination reveals localized tenderness on ulnar aspect of the wrist just distal to the ulna. PA view reveal widening of triquetrolunate joint space lateral view zigzag pattern with volar tilt of the lunate. Treatment of choice Radial gutter splint and referred to ortho. Ulnar gutter splint and referred to ortho. Short arm thumb spica splint. Long arm thumb spica splint.

Ulnar gutter splint and referred to ortho.
FOOSH with impact on hypothenar eminence complain of pain and swelling on ulnar side. Examination reveals localized tenderness on ulnar aspect of the wrist just distal to the ulna. PA view reveal widening of triquetrolunate joint space lateral view zigzag pattern with volar tilt of the lunate. Treatment of choice Radial gutter splint and referred to ortho. Ulnar gutter splint and referred to ortho. Short arm thumb spica splint. Long arm thumb spica splint.

Which of the following statements regarding clavicle fractures is correct?
80% involve the distal third of the clavicle Close reduction alleviates pain and allows for improved recovery Frequently require surgical intervention to achieve alignment. Most common location is the middle third of the clavicle. Most common mechanism of injury is forced abduction of the shoulder.

Most common location is the middle third of the clavicle.
Which of the following statements regarding clavicle fractures is correct? 80% involve the distal third of the clavicle Close reduction alleviates pain and allows for improved recovery Frequently require surgical intervention to achieve alignment. Most common location is the middle third of the clavicle. Most common mechanism of injury is forced abduction of the shoulder.

Which of the following immobilization methods is indicated for a nondisplaced scaphoid fracture?
Long arm volar splint. Short arm thumb spica splint Short arm volar splint Sling alone, no splint required Ulnar gutter splint.

Short arm thumb spica splint
Which of the following immobilization methods is indicated for a nondisplaced scaphoid fracture? Long arm volar splint. Short arm thumb spica splint Short arm volar splint Sling alone, no splint required Ulnar gutter splint.

One of the landmark on the dorsum of the wrist is “ anatomic snuffbox “ the scaphoid is palpable within this triangle formed by: Radial styloid at its proximal base, extensor pollicis brevis tendon at its radial aspect and the extensor pollicis longus tendon at its ulnar aspect. Radial styloid at its proximal base, extensor pollicis brevis tendon at its ulnar aspect and the extensor pollicis longus tendon at its radial aspect. Radial styloid at its distal base, extensor pollicis brevis tendon at its ulnar aspect and the extensor pollicis longus tendon at its radial aspect.

In an otherwise normal x-ray, the finding of a “posterior fat pad “ on a lateral x-ray of the elbow in adult and pediatric patients is suggestive of which of the following ? Normal finding in adults, supracondylar fracture in children. Supracondylar fracture in adults and children. Radial head fracture in adults, supracondylar fracture in children. Olecranon fracture in adults, supracondylar fracture in children. Radioulnar dislocation in adults, supracondylar fracture in children.

Supracondylar fracture in adults and children.
In an otherwise normal x-ray, the finding of a “posterior fat pad “ on a lateral x-ray of the elbow in adult and pediatric patients is suggestive of which of the following ? Normal finding in adults, supracondylar fracture in children. Supracondylar fracture in adults and children. Radial head fracture in adults, supracondylar fracture in children. Olecranon fracture in adults, supracondylar fracture in children. Radioulnar dislocation in adults, supracondylar fracture in children.

Middle age male fall on outstretched hand, on examination patient usually holds the elbow in 45 degree of flexion. The olecranon is directed posteriorly. This presentation may resemble witch of the following injury presentation: Dislocation of the elbow posteriorly. Supracondylar fracture. Radial head fracture. intercondylar fracture. Both A & B. Both A & C.

Middle age male fall on outstretched hand, on examination patient usually holds the elbow in 45 degree of flexion. The olecranon is directed posteriorly. This presentation may resemble witch of the following injuries presentation: Dislocation of the elbow posteriorly. Supracondylar fracture. Radial head fracture. intercondylar fracture. Both A & B. Both A & C.

The most common neurovascular injury in supracondylar fracture is
Radial nerve. Anterior interosseus nerve. Posterior interosseus nerve. Medial nerve. Ulnar nerve.

Anterior interosseus nerve.
The most common neurovascular injury in supracondylar fracture is Radial nerve. Anterior interosseus nerve. Posterior interosseus nerve. Medial nerve. Ulnar nerve.

The most common neurovascular injury in olecranon fracture is
Poterior interosseus nerve. Anterior interosseus nerve. Medial nerve. Ulnar nerve. Radial nerve.

Repeated valgus stress such as throwing a base-ball “ little league elbow “ are mechanism of witch of the following fracture: Medial condyle fracture. Medial epicondyle fracture. Lateral condyle fracture. Lateral epicondylre fracture.

Medial epicondyle fracture.
Repeated valgus stress such as throwing a base-ball “ little league elbow “ are mechanism of witch of the following fracture: Medial condyle fracture. Medial epicondyle fracture. Lateral condyle fracture. Lateral epicondylre fracture.

Which of the following indicate intact median nerve function:
Ability to abduct the index finger against resistance and the intact sensation on radial side of the palm Abduction the thumb against resistance and intact sensation on ulnar side of the palm. Abduction the thumb against resistance and intact sensation on radial side of the palm Ability to abduct the index finger against resistance and the intact sensation on ulnar side of the palm.

The most common elbow fracture is
Intercondylar fracture Radial head fracture Olecranon fracture Supracondylar fracture

Radial head fracture The most common elbow fracture is
Intercondylar fracture Radial head fracture Olecranon fracture Supracondylar fracture

Regarding olecranon fracture, it is important to note any displacement if:
> 1 mm > 2 mm > 3 mm > 4 mm

Fracture of the proximal ulnar shaft with a radial head dislocation
Fracture of the proximal ulnar shaft with a radial head dislocation. Known as Galeazzi`s fracture-dislocation. Monteggia`s fracture-dislocation. Smith`s fracture. Colles fracture.

Monteggia`s fracture-dislocation.
Fracture of the proximal ulnar shaft with a radial head dislocation. Known as Galeazzi`s fracture-dislocation. Monteggia`s fracture-dislocation. Smith`s fracture. Colles fracture.

Isolated ulnar fracture are considered displaced if.
> 10 degree angulation or > 50% displacement. > 5 degree angulation or > 30% displacement. > 20 degree angulation or > 20% displacement. > 20 degree angulation or > 70% displacement.

> 10 degree angulation or > 50% displacement.
Isolated ulnar fracture are considered displaced if. > 10 degree angulation or > 50% displacement. > 5 degree angulation or > 30% displacement. > 20 degree angulation or > 20% displacement. > 20 degree angulation or > 70% displacement.

Most common neurovascular injure associated with monteggia`s fracture is
Radial nerve. Anterior interosseus nerve. Posterior interosseus nerve. Medial nerve. Ulnar nerve.

Posterior interosseus nerve.
Most common neurovascular injure associated with monteggia`s fracture is Radial nerve. Anterior interosseus nerve. Posterior interosseus nerve. Medial nerve. Ulnar nerve.

Which of the following is true regarding posterior shoulder dislocations?
External rotation is usually intact. Neurovascular injury is more common than in anterior dislocation. The absence of pain excludes the diagnosis. Seizures are a common mechanism of injury Recurrent injury is more common than in anterior dislocations.

Seizures are a common mechanism of injury
Which of the following is true regarding posterior shoulder dislocations? External rotation is usually intact. Neurovascular injury is more common than in anterior dislocation. The absence of pain excludes the diagnosis. Seizures are a common mechanism of injury Recurrent injury is more common than in anterior dislocations.

Which of the following is TRUE regarding monteggia`s fracture- dislocation? (A) Associated radial head dislocations are rare. (B) These types of fractures are classified according to the location of the ulnar fracture and the direction of the radial head dislocation. (C) Most of these fractures are treated with closed reduction and prolonged cast immobilization. (D) All of the above

Which of the following is TRUE regarding monteggia`s fracture-dislocation? (A) Associated radial head dislocations are rare. (B) These types of fractures are classified according to the location of the ulnar fracture and the direction of the radial head dislocation. (C) Most of these fractures are treated with closed reduction and prolonged cast immobilization. (D) All of the above

Which of the following is TRUE regarding acromioclavicular joint injuries? (A) It is difficult to diagnose them clinically. (B) Most injuries occur in the elderly. (C) A coracoclavicular gap differential of more than 5 mm between the injured & uninjured shoulders is diagnostic of a type 3 injury. (D) Treatment of most injuries consists of analgesia, rest, and immobilization in a simple sling.

A 35-year-old man presents with left wrist pain following a fall off a snowboard. A radiograph reveals a Colles' fracture of the distal radius. Which of the following is TRUE regarding Colles' fractures? (A) Stable Colles' fractures can be treated with a wrist splint for 6 weeks. (B) The goals of reduction are to restore the dorsal tilt, radial inclination, and proper length to the radius. (C) Associated ulnar styloid fractures may indicate disruption of the cartilaginous structures stabilizing the wrist. (D) The x-ray demonstrates volar angulation of the distal radius.

A 26-year-old man is brought to the trauma room after a high- speed motorcycle accident. He has suspected injuries to the abdomen and head as well as an obvious deformity of the left elbow. The left hand is dusky and cool, and pulses are difficult to palpate. What is the MOST appropriate next step in the management of this injury? (A) Obtain elbow films immediately as other trauma radiographs are obtained. (B) Call the orthopedist on call immediately to request assistance for the reduction. (C) Perform immediate reduction prior to obtaining radiographs (D) Attempt reduction only after radiographic (E) check for volkmann`s ischemia. .

An 8-year-old football player is brought to your ED with an anxious set of parents and right shoulder pain. Radiographs reveal a minimally displaced midshaft fracture of the right clavicle. The parents ask you to tell them everything they need to know about the injury. Which of the following statements is TRUE? (A) This is an uncommon place for a clavicular fracture to occur. (B) A figure-of-eight harness is necessary for proper healing. (C) The patient will likely have chronic shoulder pain as an adult. (D) This fracture may be associated with intrathoracic injury.

Which of the following is TRUE regarding scapular fractures
Which of the following is TRUE regarding scapular fractures? (A) They are seldom associated with other injuries. (B) Most require surgical fixation to ensure long-term shoulder function. (C) They are usually the result of severe trauma. (D) Fractures of the acromion and the scapular spine are the most common.

For which of the following patients can the cervical spine be clinically "cleared" by NEXUS criteria? (A) The 18-year-old woman complaining of severe left leg pain with an obvious deformity after a motor vehicle accident. (B) The 65-year-old man with tenderness to palpation along the lateral cervical musculature but no midline tenderness along the bony prominences. (C) The 48-year-old man with a Glasgow Coma Scale score of 14 and repetitive questioning after a motor vehicle accident who insists, "Nothing is wrong with me, let me go!" (D) The 33-year-old football player with tingling in his left fingers but no neck pain after being tackled to the ground during practice.

Which of the following is TRUE regarding cervical spine injuries
Which of the following is TRUE regarding cervical spine injuries? (A) Fanning or widening of the spinous processes may indicate an injury to the anterior ligamentous structures. (B) Injuries to the transverse ligament of the odontoid can occur without bony fracture and should be considered unstable injuries. (C) The flexion-teardrop fracture is considered mechanically stable. (D) A bilateral interfacetal dislocation ("locked facets") is considered mechanically stable.

Which of the following cervical vertebral levels exhibit pseudosubluxation in almost half of all pediatric patient? C 1-2 C 2-3 C 3-4 C 4-5 C 5-6

Which of the following cervical spine vertebrae is most commonly fractured from falls in the elderly? C 1 C 2 C 3 C 4 C 7

A 75-year-old man presents with a fall on outstretched hand
A 75-year-old man presents with a fall on outstretched hand. Radiographs demonstrate a distal radius fracture with dorsal displacement of the distal segment. Which of the following is the most likely nerve injury? Median Radial Ulnar Axillary vagus

A 3-year-old girl presents with right elbow pain after being pulled by the hand by her mother. There is no history of trauma. She has minimal tenderness of the elbow, but refuses to use her right upper extremity. Which of the following is the most appropriate next step in management? Elbow x-rays Wrist x-rays Flexion and hyperpronation of the forearm Extension and hyperpronation of the forearm. Extension and supination of the forearm.

Flexion and hyperpronation of the forearm
A 3-year-old girl presents with right elbow pain after being pulled by the hand by her mother. There is no history of trauma. She has minimal tenderness of the elbow, but refuses to use her right upper extremity. Which of the following is the most appropriate next step in management? Elbow x-rays Wrist x-rays Flexion and hyperpronation of the forearm Extension and hyperpronation of the forearm. Extension and supination of the forearm.

A 27-year-old man is brought to the ED after a motor vehicle accident complaining of right arm pain. His arm is swollen and shortened compared with the unaffected side. His x-ray reveals humeral shaft fracture. Which of the following associated finding is most likely to be present upon physical examination? In ability to extend the wrist Loss of two-point discrimination at the volar tip of the index finger. Absence of a radial pulse Inability to oppose the thumb Hypoesthesia of the palmer aspect of the little and ring fingers

In ability to extend the wrist
A 27-year-old man is brought to the ED after a motor vehicle accident complaining of right arm pain. His arm is swollen and shortened compared with the unaffected side. His x-ray reveals humeral shaft fracture. Which of the following associated finding is most likely to be present upon physical examination? In ability to extend the wrist Loss of two-point discrimination at the volar tip of the index finger. Absence of a radial pulse Inability to oppose the thumb Hypoesthesia of the palmer aspect of the little and ring fingers

Which of the following is true regarding sternoclavicular joint injuries?
Sternoclavicular joint is the most frequently moved nonaxial joint. the lest commonly dislocated major joint in the body. Anterior dislocation are more common than posterior dislocation Patient with posterior dislocation may present with dysphagia, hoarseness, dyspnea, upper extremity paresthesias and weakness. All of the above

Which of the following methods of reducing an anterior shoulder dislocation is associated with the highest incidence of complication and is no longer recommended? External rotation maneuver of liedelmeyer. Forward elevation maneuver of cooper and Milch. Hippocratic method of traction with foot in axilla Snowbird traction technique. Stimson hanging weight technique.

Hippocratic method of traction with foot in axilla
Which of the following methods of reducing an anterior shoulder dislocation is associated with the highest incidence of complication and is no longer recommended? External rotation maneuver of liedelmeyer. Forward elevation maneuver of cooper and Milch. Hippocratic method of traction with foot in axilla Snowbird traction technique. Stimson hanging weight technique.

A 27-year-old man is brought to the ED after a motor vehicle accident complaining of right arm pain. His arm is swollen and ecchymosis and the arm held closely against the chest wall. His x-ray reveals proximal humeral fracture. Which of the following type of fracture most commonly cause axillary neurovascular injury & brachial plexus? Anatomic neck fracture Greater tuberosity fracture Lesser tuberosity fracture Surgical neck fracture

Surgical neck fracture
A 27-year-old man is brought to the ED after a motor vehicle accident complaining of right arm pain. His arm is swollen and ecchymosis and the arm held closely against the chest wall. His x-ray reveals proximal humeral fracture. Which of the following type of fracture most commonly cause axillary neurovascular injury & brachial plexus? Anatomic neck fracture Greater tuberosity fracture Lesser tuberosity fracture Surgical neck fracture

Regarding prevertebral soft tissue distance, which of the following considered normal?
< 7mm at C 2 or < 5 mm at C 3-4. < 5 mm at C 2 or < 7 mm at C 3-4. < 3 mm at C 2 or < 5 mm at C 3-4. < 3 mm at C 2 or < 5 mm at C 7

< 7mm at C 2 or < 5 mm at C 3- 4.
Regarding prevertebral soft tissue distance, which of the following considered normal? < 7mm at C 2 or < 5 mm at C 3- 4. < 5 mm at C 2 or < 7 mm at C 3-4. < 3 mm at C 2 or < 5 mm at C 3-4. < 3 mm at C 2 or < 5 mm at C 7

Which of the following cervical fracture considered stable
Simple wedge fracture Extension teardrope fracture Pillar fracture Flexion teardrop fracture Burst fracture.

Regarding odontoid fracture that occur at the junction of odontoid and the body of C 2, classified as: Type 1 Type 2 Type 3 Type 4

Clay-shoveler`s fracture an avulsion of the spinous process, of which cervical vertebrae?

The most common associated injure with scapular fracture is
Pulmonary injury Humeral head injury Rib fracture Shoulder girdle injury

A 23-year-old man presents with shoulder pain after falling
A 23-year-old man presents with shoulder pain after falling. A shoulder radiograph is shows anterior shoulder dislocation, which of the following is the most likely additional injury? Humeral head fracture Glenoid rim disruption Brachial artery injury Acromioclavicular (AC ) separation. Clavicular fracture.

Chapter 269-272 BY Sameh sejiney MD.

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Chapter 269-272 BY Sameh sejiney MD.

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