Musculoskeletal and Orthopedic Disorders Flashcards

A 24-year-old twists an ankle playing basketball and cannot bear weight for four steps. Which finding most strongly supports obtaining an ankle radiograph under the Ottawa ankle rules?

Answer: Bone tenderness at the posterior edge or tip of the lateral malleolus

Inability to bear weight or bony tenderness at the malleolar posterior edge/tip meets Ottawa criteria for imaging.

A patient has snuffbox tenderness after a fall on an outstretched hand, but initial wrist radiographs are normal. What is the best next step?

Answer: Thumb spica splint with repeat imaging or MRI in 7-10 days

Occult scaphoid fractures are common and risk avascular necrosis, so immobilize and re-image.

An obese 13-year-old boy has several weeks of knee pain and an externally rotated, limp-causing hip with limited internal rotation. What is the most appropriate management?

Answer: Non-weight-bearing status and urgent orthopedic referral

Referred knee pain with limited hip internal rotation suggests slipped capital femoral epiphysis, which needs surgical pinning.

A 70-year-old falls on an outstretched hand and has a 'dinner fork' deformity of the wrist. Which fracture is most likely?

Answer: Colles fracture

A Colles fracture is a dorsally displaced distal radius fracture producing the dinner fork deformity.

Following a tibial shaft fracture, a patient has escalating pain unrelieved by opioids. Which finding is the earliest and most reliable sign of compartment syndrome?

Answer: Pain with passive stretch of the muscles in the compartment

Pain out of proportion and pain on passive stretch precede the late signs of pulselessness, pallor, and paralysis.

A 2-year-old suddenly refuses to use her arm after being pulled by the hand, holding it extended and pronated without swelling. What is the best treatment?

Answer: Closed reduction by hyperpronation or supination-flexion

Radial head subluxation (nursemaid's elbow) is reduced with a hyperpronation or supination-flexion maneuver.

An 82-year-old woman after a fall has a shortened, externally rotated right leg and groin pain. What is the most likely diagnosis?

Answer: Hip fracture

Leg shortening with external rotation after a fall in an older adult is classic for proximal femur fracture.