Chapter 29 Orthopaedic Injuries

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  1. The muscular system includes three types of muscles:
    • skeletal
    • smooth
    • cardiac
  2. Skeletal muscle tissue is directly attached to the bone by tough, rope-like fibrous structures known as ____.  ____ are extensions of the fascia that covers all skeletal muscle.
  3. ____ muscle, also called involuntary muscle because it is not under voluntary control of the brain, performs much of the automatic work of the body.
  4. The skeleton is made up of approximately ____ bones
  5. shoulder blade
  6. The pectoral (shoulder) girdle consists of:
    • two scapulae
    • two clavicles
  7. collarbone
  8. The clavicle (collarbone) is a slender, S-shaped bone attached by ligaments to the sternum on one end and to the ____ ____ on the other.
    acromion process
  9. The upper extremity extends from the shoulder to the fingertips and is composed of the arm (____), elbow, forearm (____ and ____), wrist, hand, and fingers.
    • humerus
    • radius
    • ulna
  10. The upper extremity joins the shoulder girdle at the ____ joint.
  11. The ____, the larger of the two forearm bones, lies on the thumb side of the forearm.
  12. The ____ is narrow and is on the little-finger side of the forearm.
  13. Wrist bones
  14. Hand bones
  15. Finger bones
  16. The pelvic girdle is actually three separate bones fused together to form the innominate bone:
    • Ischiumii
    • Iliumiii
    • Pubis
  17. The pelvic girdle is actually three separate bones fused together to form the ____ bone.
  18. The ____ (thigh bone) is a long, powerful bone that connects in the ball-and-socket joint of the pelvis and in the hinge joint of the knee.
  19. The lower leg consists of two bones:
    • tibia
    • fibula
  20. The ____ (shinbone) connects to the ____ (kneecap) to form the knee joint and runs down the front of the lower leg.
    • tibia
    • patella
  21. The much smaller ____ runs behind and beside the tibia.
  22. ankle bones
  23. foot bones
  24. toe bones
  25. The largest of the tarsal bones is the heel bone, or ____, which is subject to injury when a person jumps from a height and lands on the feet.
  26. Joints are held together in a tough fibrous structure known as a ____, which is supported and strengthened in certain key areas by bands of fibrous tissue called ____.
    • capsule
    • ligaments
  27. In moving joints, the ends of bones are covered with a thin layer of cartilage known as ____ cartilage.
  28. A potential complication of fractures is ____ ____.
    compartment syndrome
  29. A potential complication of fractures is compartment syndrome - elevated pressure within a ____ compartment.
  30. A ____ is a disruption of a joint in which the bone ends are no longer in contact.
  31. A ____ is similar to a dislocation except the disruption of the joints is not complete.  Therefore, a ____ is an incomplete dislocation of a joint.
  32. A ____ is an injury to ligaments, articular capsule, synovial membrane, and tendons crossing the joint.
  33. The three most vulnerable joints in a sprain:
    • knees
    • shoulders
    • ankles
  34. A ____, or muscle pull, is a stretching or tearing of the muscle, causing pain, swelling, and bruising of the soft tissues in the area.
  35. -It occurs because of an abnormal contraction.
    -May range from minute separation to complete rupture.
    -No ligament or joint damage typically occurs.
  36. A ____ ____ fractures the bone at the point of impact.
    direct blow
  37. ____ ____ may cause a fracture or dislocation at a distant point.
    Indirect force
  38. ____ ____ are a common cause of musculoskeletal injury, especially to the anterior cruciate ligament in the knee.
    Twisting forces
  39. ____-____ injuries produce severe damage to the skeleton, surrounding soft tissues, and vital internal organs.
  40. Fractures are classified as either:
    closed or open.
  41. Your first priority with a fracture is to determine whether:
    the overlying skin is damaged.
  42. With an ____ fracture, there is an external wound, caused either by the same blow that fractured the bone or by the broken bone ends lacerating the skin.
  43. A ____ fracture (also known as a hairline fracture) is a simple crack of the bone that may be difficult to distinguish from a sprain or simple contusion.
  44. A ____ fracture produces actual deformity, or distortion, of the limb by shortening, rotating, or angulating it.
  45. An incomplete fracture that passes only partway through the shaft of a bone and occurs in children.
  46. A fracture in which the bone is broken into more than two fragments.
  47. A fracture of weakened or diseased bone generally produced by minimal force as seen in patients with osteoporosis or cancer.
  48. A fracture in which the bone is broken at an angle across the bone.  Usually a result of a sharp-angled blow to the bone.
  49. A fracture that occurs straight across the bone.  Usually the result of a direct blow or stress fracture caused by prolonged running.
  50. A fracture caused by a twisting force, causing an oblique fracture around the bone and through the bone.  Often the result of abuse in very young children.
  51. A fracture that does not run completely through the bone.
  52. Sometimes a dislocated joint will ____ ____, or return to its normal position, before your assessment.
    spontaneously reduce
  53. A ____ occurs when a joint is twisted or stretched beyond its normal range of motion.
  54. A ____ should be considered a partial dislocation or subluxation.
  55. A ____ is an injury to a muscle and/or tendon that results from a violent muscle contraction or from excessive stretching.
  56. Compartment syndrome most often occurs with a fractured ____ or ____ of children.
    • tibia
    • forearm
  57. You must assess neurovascular function every __ to __ minutes during the assessment, depending on the patient’s condition, until he or she is in the hospital.
    5 to 10
  58. Examination of the injured limb should include the 6 Ps of musculoskeletal assessment:
    • pain
    • paralysis
    • paresthesias (numbness or tingling)
    • pulselessness
    • pallor
    • pressure
  59. Unless the patient’s life is in immediate danger, you should ____ all fractures, dislocations, and sprains before moving the patient.
  60. Application of ____-____ ____is the act of pulling on a body structure in the direction of its normal alignment.
    in-line traction
  61. The amount of traction that is required varies but often does not exceed __ lb.
  62. It takes ____ EMTs to apply a rigid splint.
  63. The most commonly used formable or soft splint is the precontoured, ____, clear plastic air splint.
  64. Always inflate the splint ____ applying it.
  65. Air splints are used to stabilize injuries below the ____ or below the ____.
    • elbow
    • knee
  66. Traction splints are used primarily to secure fractures of the shaft of the ____, which are characterized by pain, swelling, and deformity of the midthigh.
  67. Traction splints are not suitable for use on the ____ extremity because the major nerves and blood vessels in the patient’s axilla cannot tolerate countertraction forces.
  68. ____ ____ are used to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain.
    Pelvic binders
  69. If a patient has injuries to the lower extremities or pelvis, you may be able to use a ____ ____ ____ as a splinting device.
    Pneumatic antishock garment (PASGs)
  70. A patient with a ____ limb must be given a higher priority.
  71. If the treatment facility is an hour or more away, a patient with a ____ limb should be transported by helicopter or immediate ground transportation.
  72. Fractures of the ____ occur most often in children when they fall on an outstretched hand.
  73. Because the clavicle is subcutaneous, the skin will occasionally “____” over the fracture fragment.
  74. The joint between the outer end of the clavicle and the acromion process of the scapula is called the ____ (AC) joint.
  75. This type of fracture, also known as a supracondylar or intercondylar fracture, is common in children.
    Fracture of the distal humerus
  76. An isolated fracture of the shaft of the ulna may occur as the result of a direct blow to it.  This is known as a ____ fracture.
  77. Fractures of the distal radius, which are especially common in elderly patients with osteoporosis, are often known as ____ fractures.  The term “____ ____ deformity” is used to describe the distinctive appearance of the patient’s arm.
    • Colles
    • silver fork
  78. When caring for patients who have fallen, you must identify the ____-____-____ and the MOI so that you will not overlook associated injuries.
  79. A ____ fracture is an incomplete fracture that passes only partway through the shaft of the bone but may still cause severe angulation.
  80. Fractures are almost always associated with ____ of the surrounding soft tissue.
  81. True or false?  Compartment syndrome usually occurs with a fractured femur.
    False.  Tibia or forearm.
  82. True or false.  Decreased resistance to any movement of the joint is a sign of hip dislocation.
  83. Fracture of the tibia and fibula are often associated with ____ injury as a result of the distorted positions of the limb following injury.
  84. True or false?  You should use traction to reduce a fracture and force all bone fragments back into alignment.
    False.  Traction realigns fracture of a long bone to better allow splinting.
  85. Return a dislocated joint or fractured bone back to its original position; set.
  86. A bandage that passes around the chest to secure an injured arm to the chest.
  87. How should the EMT take care of a dislocated shoulder?
    A. Put the arm in a sling.
    B. Tie the arm against the chest with a triangle bandage.
    C. Lift the arm straight out and splint it in place.
    D. Pad between the arm and the chest and sling the arm.
    D. Pad between the arm and the chest and sling the arm.
    (this multiple choice question has been scrambled)
  88. Which of the following is not a contraindication to the use of the pneumatic antishock garment (PASG)?
    A. pelvis fracture
    B. pulmonary edema
    C. groin injury
    D. pregnancy
    A. pelvis fracture
    (this multiple choice question has been scrambled)
  89. A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the knee. Distal circulation and sensory and motor functions are intact. The MOST appropriate method of splinting this injury involves:
    A. applying a traction splint to realign the deformity.
    B. binding the legs together and elevating them 6″ to 8″.
    C. applying and fully inflating the pneumatic antishock garment (PASG).
    D. applying padded board splints to both sides of the leg.
    D. applying padded board splints to both sides of the leg.
    (this multiple choice question has been scrambled)
  90. A 21-year-old male was thrown over the handlebars of his motorcycle when he rear-ended a car that was stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious, but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting his spine, you should:
    A. bind his legs together on the backboard, keep him warm, and transport without delay.
    B. apply the PASG to stabilize his femurs and transport at once.
    C. splint each of his deformed femurs with long board splints and transport immediately.
    D. apply traction splints to both of his legs, keep him warm, and transport without delay.
    A. bind his legs together on the backboard, keep him warm, and transport without delay.
    (this multiple choice question has been scrambled)
  91. A “hip” fracture is actually a fracture of the:
    A. proximal femur.
    B. pubic symphysis.
    C. femoral shaft.
    D. pelvic girdle.
    A. proximal femur.
    (this multiple choice question has been scrambled)
  92. The MOST commonly fractured bone(s) in the body is the:
    A. clavicle.
    B. midshaft femur.
    C. scapula.
    D. radius and ulna.
    A. clavicle.
    (this multiple choice question has been scrambled)
  93. A 77-year-old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her head or losing consciousness.  Assessment of her left leg reveals that it is shortened and externally rotated. Distal pulses, sensory, and motor functions are intact. You should:
    A. carefully slide a long backboard underneath her, keep her in a supine position, and apply a splint to her leg.
    B. place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.
    C. bind both of her legs together with triangular bandages and carefully secure her onto the ambulance stretcher.
    D. manually stabilize her left leg, apply a traction splint, and then secure her to a long backboard or scoop.
    B. place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.
    (this multiple choice question has been scrambled)
  94. A 45-year-old female was the unrestrained passenger of a small car that rear-ended another vehicle at a moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is visible damage to the dashboard on the passenger's side of the vehicle. In addition to fractures or dislocations of the knees, you should be MOST suspicious for:
    A. a thoracic spine fracture.
    B. posterior hip dislocation.
    C. anterior hip dislocation.
    D. fracture of the tibia or fibula.
    B. posterior hip dislocation.
    (this multiple choice question has been scrambled)
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Chapter 29 Orthopaedic Injuries
Chapter 29 Orthopaedic Injuries
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