Page 1 of 2: [EMQ] Orthopaedics: Fractures: Dx: Diagnosis

RUSLAL · Credits: 12174 My Scrapbook

Options -

A. Fracture distal end of radius
B. Metacarpal fracture
C. Supracondylar fracture of humerus
D. Scaphoid fracture
E. Posterior dislocation of shoulder joint
F. Anterior dislocation of shoulder joint
G. Perilunate fracture
H. Pulled elbow

1)A man complained of pain in hand after punching a wall yesterday
2)A young girl fell from a tree and now complains of pain in the arm. Her radial pulse cannot be felt
3)A man having seizures came to the A&E complaining of pain in the shoulder. There was no obvious visible deformity
4)An old lady complained of pain in the wrist and hand after she fell on an outstretched hand. Her wrist and hand are swollen.
5)A 3 yr old girl tripped while holding her mothers hand. She has not used her arm since then

Guest · Credits: 79379 My Scrapbook My Reading List 262569 Books

1) metacarpal fracture??

2)supracondylar fracture?

3)post dislocn shoulder 4)colles fracture 5)pulled elbow

Bruno · Credits: 45896 My Scrapbook My Reading List 50 Books

3)anterior dislocation

RUSLAL · Credits: 12174 My Scrapbook

1)Ans: B. Metacarpal fracture
[Explanation - Pain is in the hand (only metacarpal is the anatomical structure of the options given that lies in the hand)]

2)Ans: C. Supracondylar fracture of humerus
[Explanation - This is a common injury following fall on an outstretched hand, especially in young age group. Extension type is more common; the distal end presses on the brachial artery; resulting in absence of radial pulse]

3) Ans: E. Posterior dislocation of shoulder joint

4) Ans: G. Perilunate fracture

5) Ans: F. Anterior dislocation of shoulder joint
[Explanation - This wont be pulled elbow, as the question says the child has not used her arm (not forearm)]

Bruno · Credits: 45896 My Scrapbook My Reading List 50 Books

My Experience as a Post Gradudate in Department of Orthopaedics and Traumatology and my Work in Accident and Trauma Wards has given me the knowledge that

1. A 3 year old girl will not use arm even for a greenstick fracture of Forearm bones due to PAIN

2. I have not yet seen a case of Anterior Dislocation Shoulder so far in a girl aged 3 years

The commonest injury in this age group
Greenstick Fractures
Pulled Elbows

3. The commonest dislocation of Shoulder is Anterior Dislocation

Any how, I am a orthopaedics Drop out and I welcome opinions from Full Fledged orthopaedicians (Dr.Chachoch.......... for example)

chachoch · Credits: 13527 My Scrapbook

Bruno,

I'm not yet qualified to be a 'full time Orthopedician'. But I'm about to start on July 1st.

I agree with you Bruno about the last question's answer being "pulled elbow". Reasoning is the same.

Cheers

Dr. Kay

drmalik · Credits: 108 My Scrapbook

whats best treatment for cole's fracture

bdb · Credits: 2227 My Scrapbook

Hi fellas,
Well we have a controversy over here.

1. A greenstick fracture or a pulled elbow is definitely more likely in a 3 yr old. And a dislocated shoulder is definitelty uncommon in a child, more so an anterior dislocation.

2.This brings me to the earlier question about the man with seizures. Anterior dislocation is more common than posterior in the general population but a posterior dislocation is more common in a patient with seizures, like in an epileptic.

Now coming to the part about treatment of colle's fracture, the options available are:

1. Closed manipulative reduction and below elbow moulded POP cast.
2. External fixation (ex: JESS, UMEX, PenniG's)/ Bone grafting(BG)
3. Closed k-wire fixation/ BG
4. Buttress Plating / BG

Good luck!

BDB

BRAVO · Credits: 46105 My Scrapbook

this came as a theme 4 plab1 exam in march2004,y r we discussing this in this forum ,i agree with the guest answer june21

take care

BRAVO

Guest · Credits: 79379 My Scrapbook My Reading List 262569 Books

Closed reduction and k- wire pinning is the gold standard for Colle's without comminution, otherwise ex fix should be the option, bone grafting is done only in selected cases.
Buttress plating and other procedures should be reserved for IA involvment only

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