4.4 of 97 Ratings
A 37-year-old geocentric athlete presents to the trauma bay after a fall while free solo rock climbing. Upon presentation, he is complaining of isolated right knee pain and deformity. After appropriate ATLS stabilization, he is found to have the injury depicted in Figure A. Successful closed reduction is performed by the orthopedic resident on duty. What is the best next step in evaluating this patient for a vascular injury and what result would warrant concern for vascular injury?
Ankle systolic blood pressure/Brachial systolic blood pressure; 0.8
Ankle systolic blood pressure/Brachial systolic blood pressure; 0.9
Ankle diastolic blood pressure/Brachial diastolic blood pressure; 0.8
Ankle diastolic blood pressure/Brachial diastolic blood pressure; 0.9
Brachial systolic blood pressure/Ankle systolic blood pressure; 0.8
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A 22-year-old college student sustains a twisting injury to his knee while walking down a wet flight of concrete stairs. He is unable to bear weight and is taken to the local trauma center by emergency medical services. Radiographs obtained in the trauma bay are shown in Figures A and B. He is closed reduced under conscious sedation, and post-reduction radiographs demonstrate a congruent joint. He is sent for an MRI of his knee, and follows up in your clinic the next week. Which of the following is true regarding the definitive treatment of his injuries in an acute (< 3 weeks from time of injury) fashion?
Acute treatment is associated with lower rates of residual knee instability when compared to staged or chronic treatment
Acute treatment is associated with the highest rates of good to excellent subjective outcomes
Acute treatment is inferior to definitive nonoperative management
Aggressive postoperative range of motion is associated with increased joint instability following acute treatment
Patients managed acutely are more likely to have postoperative stiffness recalcitrant to intervention
A 26-year-old male presents to the emergency department with complaints of knee pain. He is a gymnast and states that just prior to arrival he sustained a twisting injury to the knee while landing on a trampoline. Figure A is the radiograph that was obtained in the emergency department. An attempt at reduction in the emergency department is unsuccessful. Which of the following clinical images would be expected in this scenario?
A 32-year-old professional skydiver lands awkwardly during a jump. He presents to the emergency room with bilateral knee injuries. Following successful closed reduction of both extremities, both feet are warm and pulses are present. Bedside doppler assessment is performed and the results are seen in Figure A. What would be the most appropriate next step in treatment?
Long-leg splinting of bilateral lower extremities, monitoring of bilateral pedal pulses for 48 hours
Intravenous dextran administration, repeat doppler evaluation at 6 hourly intervals
Perform CT angiography for bilateral lower extremities
Perform CT angiography for the left lower extremity, monitor right pedal pulses for 48 hours
Surgical exploration of bilateral lower extremities
A 30-year-old man is the front seat passenger in a motor vehicle accident. He presents with deformity in his knee seen in Figures A and B. Radiographs are seen in Figures C and D. Examination reveals weak foot pulses. After unsuccessful attempts at closed reduction, it is noted that the pulses are no longer palpable and the foot is cool. What is the next step in treatment?
Open reduction through an anteromedial approach, spanning external fixation. If pulses do not return, perform popliteal artery exploration.
Closed reduction in the operating room using a femoral distractor. If pulses do not return, perform on-table angiogram.
Manual in-line skeletal traction using a calcaneal pin in the emergency room, provisional long-leg splinting. If pulses do not return, perform computed tomography angiography in the radiology suite.
Manual in-line skeletal traction using a proximal tibial pin in the emergency room, provisional long-leg splinting. If pulses do not return, perform standard angiography in the angiography suite.
Open reduction through a posterior approach, spanning external fixation. If pulses do not return, perform popliteal artery exploration.
Figures A and B are radiographs of a 20-year old male athlete that sustained a high impact tackle during a football game. What percentage of these injuries will present with an associated vascular injury?