CPEN CPEN Orthopedic and Musculoskeletal Emergencies 4 â Questions and Answers
Question 1: A 10-year-old presents after falling on an outstretched hand. X-ray shows a fracture through the distal radial physis with the epiphysis displaced. Which Salter-Harris classification is this?
- Type I
- Type II (Correct answer)
- Type III
- Type IV
Correct answer: Type II
Salter-Harris Type II involves a fracture through the physis that extends into the metaphysis, making it the most common type.
Question 2: A 7-year-old with sickle cell disease presents with severe bilateral leg pain, fever, and swelling. The nurse suspects which orthopedic emergency?
- Osteomyelitis
- Septic arthritis
- Vaso-occlusive bone infarction (Correct answer)
- Legg-Calvé-Perthes disease
Correct answer: Vaso-occlusive bone infarction
Vaso-occlusive crisis in sickle cell disease causes bone infarction due to sickling within the bone marrow vasculature, presenting with severe pain and swelling.
Question 3: An 8-year-old boy presents with hip pain and a limp for 3 weeks. X-ray shows flattening of the left femoral head. Which condition is most likely?
- Slipped capital femoral epiphysis
- Legg-Calvé-Perthes disease (Correct answer)
- Septic arthritis
- Transient synovitis
Correct answer: Legg-Calvé-Perthes disease
Legg-CalvĂ©-Perthes disease is avascular necrosis of the femoral head in children aged 4â10, presenting with insidious hip pain and characteristic X-ray changes.
Question 4: A 14-year-old obese male presents with left hip and knee pain after playing basketball. His left leg is externally rotated. Which diagnosis should the nurse prioritize?
- Transient synovitis
- Legg-Calvé-Perthes disease
- Slipped capital femoral epiphysis (Correct answer)
- Hip dislocation
Correct answer: Slipped capital femoral epiphysis
Slipped capital femoral epiphysis (SCFE) is most common in obese adolescents and presents with hip or referred knee pain and external rotation of the affected leg.
Question 5: A 5-year-old is brought in with refusal to use the right arm after being swung by the arms. Examination shows the arm held in pronation with elbow slightly flexed. Which intervention is appropriate?
- Apply a posterior long arm splint and refer to orthopedics
- Perform hyperpronation or supination-flexion maneuver (Correct answer)
- Obtain an MRI of the elbow
- Administer IV analgesics before any manipulation
Correct answer: Perform hyperpronation or supination-flexion maneuver
Nursemaid's elbow (radial head subluxation) is treated with a hyperpronation or supination-flexion reduction maneuver, which is typically immediately effective.
Question 6: Following open reduction of a femur fracture, a 9-year-old develops severe pain with passive stretch of the toes and a tense, woody thigh. The nurse's priority is to:
- Elevate the extremity above heart level
- Apply ice packs to reduce swelling
- Notify the provider immediately for compartment syndrome evaluation (Correct answer)
- Administer additional opioid analgesics
Correct answer: Notify the provider immediately for compartment syndrome evaluation
The 6 Ps (pain, pressure, paralysis, paresthesia, pallor, pulselessness) indicate compartment syndrome, a surgical emergency requiring fasciotomy.
Question 7: A 12-year-old gymnast presents with wrist pain after a backward fall. X-ray is negative. The anatomic snuffbox is tender. The nurse should anticipate which next step?
- Discharge with RICE therapy
- Apply a thumb spica splint and arrange follow-up for possible scaphoid fracture (Correct answer)
- Perform immediate MRI in the ED
- Apply a volar wrist splint and discharge without follow-up
Correct answer: Apply a thumb spica splint and arrange follow-up for possible scaphoid fracture
Anatomical snuffbox tenderness with a negative X-ray is highly suspicious for scaphoid fracture; a thumb spica splint and orthopedic follow-up are indicated as scaphoid fractures can be initially radiographically occult.
CPEN CPEN Orthopedic and Musculoskeletal Emergencies 4
A 10-year-old presents after falling on an outstretched hand.
X-ray shows a fracture through the distal radial physis with the epiphysis displaced.
Which Salter-Harris classification is this?