EMQs in Clinical Medicine.pdf - Peshawar Medical College

Fall on the outstretched hand – answers 131
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A 60-year-old woman complains of pain, swelling and reduced mobility
4 months after suffering a fractured neck of femur. Her radiograph
shows absence of callus at fracture site.
Absence of callus at the fracture site implies delayed union. Malunion is
diagnosed only if the radiograph shows that the medullary cavity has
been closed off.
A 65-year-old woman who falls on an outstretched arm shows weakness
of wrist extensors.
Radial nerve supplies motor innervation to the extensors of the wrist.
Look out for signs of radial nerve injury after fracture/dislocation of the
elbow, fracture of the humerus and injury to the axillary region.
48 Management of fractures
Answers: J E F B H
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B
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A 24-year-old man presents with a swollen painful hand after a falling
over playing squash. His radiograph reveals a scaphoid fracture.
The wrist is held in dorsiflexion. A plaster cast from the wrist to above
the knuckle provides insufficient support.
A 1-year-old baby requires traction after fracture of the right femur.
This means of traction is suitable up to the age of 2 years.
A 65-year-old woman requires treatment for displaced fractured neck
of femur.
This is the management of choice and mobilization can begin immediately
because internal fixation holds a fracture very securely.
A 35-year-old woman presents after a fall on an outstretched arm.
Her radiograph shows an undisplaced transverse fracture of the right
humerus.
A collar-and-cuff sling provides sufficient support for this fracture.
A broad sling is used to stabilize a fractured clavicle.
A 75-year-old woman suffers a displaced Colles’ fracture.
The cast is applied from just below the elbow to the palm of the hand
with the wrist in the neutral position/slightly flexed.
49 Fall on the outstretched hand
Answers: F A J E K
A 24-year-old woman presents with pain on wrist movements after a
fall on to her hand. On examination there is tenderness and swelling
in the anatomical snuffbox.