Musculoskeletal Injuries 327312.A 76-year-old woman is brought into the ED complaining of hip pain
after a motor vehicle collision. She states that her knee slammed into the dash-
board after her car struck another vehicle. On examination you note her right
leg appears shortened, adducted, internally rotated, and flexed. She has no other
injuries. The radiograph of her hip confirms your diagnosis of a hip dislocation.
Which of the following statements regarding this type of injury is true?
a. The most common presentation of this injury is an abducted, externally rotated,
and flexed lower extremity.
b. This type of injury accounts for 5% to 10% of all hip dislocations.
c. The injury is commonly caused by a direct force applied to a flexed knee.
d. The most common complication is injury to the femoral artery.
e. The femoral nerve is almost always injured in this type of dislocation.
313.A 33-year-old carpenter was working on a construction project to
build a new house. While he was using a high-pressure paint gun, he inad-
vertently injected his left index finger. On arrival to the ED, he complains
of intense hand pain. On examination, you note a 2-mm wound over the
second proximal phalange. He has full range of motion and brisk capillary
refill. Radiographs of the finger show soft tissue swelling, a small amount
of subcutaneous air, but no fracture. His tetanus is up to date. Which of the
following is the most appropriate disposition for this patient?
a. Place the hand in a radial gutter splint and have the patient follow up with an
orthopedic surgeon in 1 week.
b. Discharge home with pain medication and have the patient return for repeat
radiographs in 1 week.
c. Order a CT scan of the finger to confirm that there is no occult fracture before
discharging the patient home.
d. Place the hand in a radial gutter splint, prescribe a 10-day course of antibiotics,
and have the patient follow up with an orthopedic surgeon in 1 week.
e. Place the hand in a radial gutter splint, administer broad-spectrum antibiotics,
and admit the orthopedic service for operative debridement.