Musculoskeletal Injuries Answers 341and flexed. Because of the strong forces needed to cause such an injury, hip
dislocations rarely occur in isolation. Life threatening injuries should
always be addressed first, prior to treating hip dislocations. Nonetheless,
early reduction is required since the likelihood of avascular necrosisof
the femoral head increases in direct proportion to a delay in reduction.
Early complications of posterior dislocations include sciatic nerve injury.
Late complications include avascular necrosis of the femoral head, as men-
tioned above.
(a)This is the most common presentation of an anterior hip disloca-
tion.(b)Posterior hip dislocations account for approximately 80% of hip
dislocations.(d)The most common complication is avascular necrosis.
(e)The sciatic nerve is at risk for injury.
313.The answer is e.(Simon and Koenigsknecht, p 159.)The patient sus-
tained a high-pressure injection injuryof his finger—this is a surgical
emergency. These injuries may involve extensive tissue lossand are asso-
ciated with a high infection rate.Most of these injuries involve grease,
paint, or other industrial toxins. Paint generates a large, early inflammatory
response resulting in a high percentage of amputations. Within several
hours after the digit has been injected, the extremity becomes painful and
swollen. Initially, there may be anesthesia and even vascular insufficiency
of the extremity. In the late stages, marked breakdown of the skin occurs
resulting in ulcers and draining sinuses. If the material injected into the
extremity is radiopaque, it is possible to determine its degree of spread.
Management involves splintingandelevatingthe extremity, administra-
tion of antibiotics, tetanus prophylaxisupdated as indicated, analgesia,
and immediate orthopedic consultation.
314.The answer is b.(Simon and Koenigsknecht, pp 534-539.)This indi-
vidual sustained a calcaneal fractureof the right foot. The calcaneus is the
most commonly fractured tarsal bone (a); the talus is the second most
commonly injured tarsal bone. A calcaneal fracture is usually caused by a
compression injury (d), such as a fall from a height with the patient land-
ing on his or her feet. The examination reveals swelling, tenderness, and
ecchymosis of the hindfoot and the inability to bear weight on the fracture.
10% are bilateral (c)and 10% are associated with compression fractures
of the dorsolumbar spine.Therefore, it is important to examine the
patient’s entire spine. Treatment varies depending on the extent of injury. In
general, nondisplaced or minor extra-articular fractures only require sup-
portive care with immobilization in a posterior splint and follow-up with