CPEN CPEN Orthopedic and Musculoskeletal Emergencies 1 — Questions and Answers
Question 1: A child presents with pain and inability to bear weight after a fall. Which radiographic finding is unique to pediatric fractures?
- Comminuted fracture pattern
- Salter-Harris growth plate fracture (Correct answer)
- Spiral shaft fracture only
- Open fracture with bone exposure
Correct answer: Salter-Harris growth plate fracture
Salter-Harris fractures involve the physis (growth plate) and are unique to skeletally immature patients, with classification guiding prognosis and treatment.
Question 2: Which clinical finding is the hallmark of compartment syndrome in a pediatric extremity injury?
- Ecchymosis alone
- Pain with passive stretch of the affected muscles out of proportion to the injury (Correct answer)
- Normal distal pulses
- Mild warmth and erythema
Correct answer: Pain with passive stretch of the affected muscles out of proportion to the injury
Pain with passive muscle stretch that is disproportionate to the injury is the earliest and most reliable sign of compartment syndrome.
Question 3: A 2-year-old presents with refusal to use his right arm after being lifted by the arm. Which injury is most likely?
- Clavicle fracture
- Nursemaid's elbow (radial head subluxation) (Correct answer)
- Supracondylar fracture
- Shoulder dislocation
Correct answer: Nursemaid's elbow (radial head subluxation)
Nursemaid's elbow occurs when longitudinal traction on an outstretched arm causes subluxation of the radial head beneath the annular ligament, common in toddlers.
Question 4: Which type of fracture in a young child should raise suspicion for non-accidental trauma (NAT)?
- Greenstick fracture of the radius
- Classic metaphyseal lesion or posterior rib fractures (Correct answer)
- Toddler's spiral tibial fracture from walking fall
- Clavicle fracture from delivery
Correct answer: Classic metaphyseal lesion or posterior rib fractures
Classic metaphyseal lesions (bucket-handle fractures) and posterior rib fractures are high-specificity indicators of non-accidental trauma in young children.
Question 5: What is the priority nursing intervention for a child with an open fracture?
- Apply traction to realign the bone immediately
- Cover the wound with a sterile moist dressing, immobilize, and administer antibiotics (Correct answer)
- Irrigate the wound with hydrogen peroxide
- Apply a tight circumferential bandage over the wound
Correct answer: Cover the wound with a sterile moist dressing, immobilize, and administer antibiotics
Open fractures require sterile wound coverage to reduce infection risk, proper splinting for immobilization, and prompt IV antibiotics to prevent osteomyelitis.
Question 6: A child with a suspected supracondylar fracture should be monitored closely for which neurovascular complication?
- Peroneal nerve palsy
- Anterior interosseous nerve injury and brachial artery compromise (Correct answer)
- Radial nerve palsy only
- Axillary nerve palsy
Correct answer: Anterior interosseous nerve injury and brachial artery compromise
Supracondylar fractures put the anterior interosseous nerve and brachial artery at risk due to the close proximity of these structures to the fracture site.
CPEN CPEN Orthopedic and Musculoskeletal Emergencies 1
A child presents with pain and inability to bear weight after a fall.
Which radiographic finding is unique to pediatric fractures?