Urgent Care Urgent Care for Fractures and Sprains 2 — Questions and Answers
Question 1: What is the first-line management for a Grade II lateral ankle sprain in an otherwise healthy adult?
- Surgical repair within 24 hours
- RICE protocol (rest, ice, compression, elevation) and early mobilization (Correct answer)
- Strict non-weight-bearing cast for 6 weeks
- Corticosteroid injection into the joint
Correct answer: RICE protocol (rest, ice, compression, elevation) and early mobilization
Grade II ankle sprains are managed conservatively with RICE and functional rehabilitation, allowing early return to activity.
Question 2: A child presents with elbow pain after a pulled arm. X-ray is normal. What is the most likely diagnosis?
- Lateral epicondyle fracture
- Nursemaid's elbow (radial head subluxation) (Correct answer)
- Olecranon fracture
- Medial epicondyle avulsion
Correct answer: Nursemaid's elbow (radial head subluxation)
Nursemaid's elbow occurs after axial traction on an extended arm in young children and typically has a normal X-ray; reduction is curative.
Question 3: Which fracture pattern in the distal radius is associated with dorsal angulation and is most common in elderly patients after a fall?
- Barton fracture
- Smith fracture
- Colles fracture (Correct answer)
- Chauffeur fracture
Correct answer: Colles fracture
Colles fracture involves dorsal displacement and angulation of the distal radius fragment, classic in older adults after a fall on an outstretched hand.
Question 4: When is urgent orthopedic consultation required for a long bone fracture in urgent care?
- Any closed fracture without displacement
- Open fracture with skin disruption (Correct answer)
- Minimally displaced distal radius fracture
- Non-displaced fifth metatarsal base fracture
Correct answer: Open fracture with skin disruption
Open fractures require urgent orthopedic consultation due to the risk of osteomyelitis and need for operative irrigation and debridement.
Question 5: Which of the following is the most appropriate initial imaging for a suspected stress fracture of the tibia?
- Plain X-ray (AP and lateral) (Correct answer)
- Ultrasound of the tibia
- CT scan of the leg
- Bone scan or MRI
Correct answer: Plain X-ray (AP and lateral)
Plain X-ray is the first-line imaging for suspected tibial stress fracture, though it may be negative early; MRI is more sensitive if X-ray is inconclusive.
Question 6: A patient has a non-displaced fifth metatarsal avulsion fracture. What is the appropriate treatment?
- Immediate surgical pinning
- Hard-soled shoe or walking boot and weight-bearing as tolerated (Correct answer)
- Short leg cast non-weight-bearing for 8 weeks
- Buddy taping to the fourth toe only
Correct answer: Hard-soled shoe or walking boot and weight-bearing as tolerated
Non-displaced avulsion fractures of the fifth metatarsal base are treated conservatively with a hard-soled shoe and weight-bearing as tolerated.
Urgent Care Urgent Care for Fractures and Sprains 2
What is the first-line management for a Grade II lateral ankle sprain in an otherwise healthy adult?