Musculoskeletal Injuries Answers 335298.The answer is b.(Rosen, pp 593-596.)The radiograph confirms an
anterior dislocationof the left shoulder. Patient’s typically present in
severe pain with the dislocated arm held in slight abduction and external
rotation by the opposite extremity. The patient leans away from the injured
side and cannot adduct or internally rotate the shoulder without severe
pain. Associated fractures may occur in up to 50% of anterior dislocations.
The most common of these is a compression fracture of the humeral
head,known as a Hill-Sachs deformity.
(a)Fracture of the anterior glenoid rim, or Bankart fracture, is also associ-
ated with anterior dislocations, but is present in approximately 5% of cases.
Choices (c,d,and e)are not commonly associated with anterior dislocations.
299.The answer is e.(Rosen, pp 780-783.)This patient most likely sus-
tained a closed-fist injury, which have high infection rates and evidence of
poor wound healing. Wounds sustained by punches to the jaw and human
bites, also known as “fight bites,” are classically over the metacarpal joints.
Penetration deep into the joint space and infection is common given the
positioning of the hand during the injury, human oral flora, and delay in
seeking treatment. Infected wounds are polymicrobial and specifically
includeEikenella corrodens, a facultative anaerobic gram-negative rod
harbored in human dental plaque. It acts synergistically with aerobic organ-
isms to increase the morbidity of these injuries. The joint spaces must be
examined under full range of motion to detect any tendon lacerations or
presence of foreign bodies. Hand radiographs should also be obtained to
examine for any bony involvement. IV antibioticsandadmissionis the
appropriate disposition. The antibiotics of choice are penicillin and sec-
ond-generation cephalosporinswith broader coverage in the immuno-
compromised. The wounds should be left open with a sterile dressing,
splinted in the position of function (hand-holding-glass position) and ele-
vated. Human bites have resulted in the transmission of hepatitis B, hepati-
tis C, syphilis, and herpes. Although HIV is present in human saliva, it is in
relatively small amounts and considered a low risk for transmission. Appro-
priate antivirals and testing should be considered in these patients.
(a and b)You should never suture these lacerations. (c and d)Wound
irrigation and tetanus prophylaxis is warranted in conjunction with IV
antibiotics.
300.The answer is e.(Rosen, pp 521-523.)The patient has a mallet fin-
ger or a rupture of the extensor tendonthat inserts into the base of the