Urgent Care Urgent Care for Fractures and Sprains 1 — Questions and Answers
Question 1: Which Ottawa Ankle Rule finding indicates the need for an ankle X-ray?
- Diffuse ankle swelling without point tenderness
- Point tenderness over the posterior edge or tip of the lateral malleolus (Correct answer)
- Mild bruising without bony tenderness
- Pain only with full weight bearing
Correct answer: Point tenderness over the posterior edge or tip of the lateral malleolus
The Ottawa Ankle Rules indicate X-ray if there is point tenderness over the posterior 6 cm or tip of either malleolus.
Question 2: A patient with a suspected scaphoid fracture has a normal wrist X-ray. What is the appropriate next step?
- Discharge without restriction since X-ray is negative
- Immobilize in a thumb spica splint and arrange follow-up or MRI (Correct answer)
- Apply a compression bandage and prescribe NSAIDs
- Order a CT scan immediately in urgent care
Correct answer: Immobilize in a thumb spica splint and arrange follow-up or MRI
Scaphoid fractures are frequently occult on initial X-ray; immobilization and follow-up imaging (MRI or repeat X-ray) are mandatory to prevent avascular necrosis.
Question 3: What is the primary concern with a Salter-Harris Type II fracture in a child?
- Immediate arterial injury
- Growth plate disruption potentially affecting bone growth (Correct answer)
- Infection of adjacent soft tissue
- Complete physeal arrest in all cases
Correct answer: Growth plate disruption potentially affecting bone growth
Salter-Harris fractures involve the growth plate and carry the risk of disrupting normal bone growth, depending on the type and displacement.
Question 4: Which splint position is correct for an acute ankle sprain in urgent care?
- Plantar flexion at 45 degrees
- Neutral (90-degree) position (Correct answer)
- Dorsiflexion at 20 degrees
- Maximum inversion
Correct answer: Neutral (90-degree) position
The ankle is splinted in the neutral (90-degree) position to prevent contracture and facilitate functional recovery.
Question 5: A patient presents after a fall with 'snuffbox' tenderness. Which bone is most likely fractured?
- Lunate
- Trapezium
- Scaphoid (Correct answer)
- Capitate
Correct answer: Scaphoid
Anatomical snuffbox tenderness is the hallmark clinical finding of a scaphoid fracture.
Question 6: Which physical exam finding is most concerning for a compartment syndrome following a forearm fracture?
- Mild edema at the fracture site
- Pain with passive stretch of the fingers (Correct answer)
- Bruising extending to the elbow
- Tenderness directly over the fracture line
Correct answer: Pain with passive stretch of the fingers
Pain with passive stretch of muscles in the affected compartment is the earliest and most sensitive sign of compartment syndrome.
Urgent Care Urgent Care for Fractures and Sprains 1
Which Ottawa Ankle Rule finding indicates the need for an ankle X-ray?