342 Emergency Medicine
an orthopedic surgeon (e).The management of intra-articular or displaced
calcaneal fractures remains controversial regarding nonoperative versus
immediate surgical reduction.
315.The answer is e.(Simon and Koenigsknecht, pp 266-272.)Humeral
shaft fracturesmost commonly occur from a direct blow to the mid-upper
arm. The fracture usually involves the middle third of the humeral shaft.
The most common associated injury is damage to the radial nervethat
causes wrist drop and loss of sensation in the first dorsal web space. Ulnar
and median nerve injuries may also occur but are much less common.
Olecranon fractures (a)are associated with injury to the ulnar nerve.
Individuals may experience paresthesias and numbness in the ulnar nerve
distribution or weakness of the interossei muscles. Posterior elbow disloca-
tions(b)are associated with injuries to the ulnar and median nerves. Ante-
rior elbow dislocations (c), although uncommon, have a much higher
incidence of vascular injuries than posterior dislocations. It is important to
evaluate for a brachial artery injury. Supracondylar fractures (d), common
in young individuals, are associated with injuries to the brachial artery and
median nerve as the distal humeral fragment is displaced posteriorly, thus
placing the sharp fracture fragments anteriorly.
316.The answer is a.(Simon and Koenigsknecht, pp 217-220.)Monteggia
fracturesare of the proximal one-third of the ulnar shaftcombined with
aradial head dislocation.This injury commonly occurs from either a
direct blow to the posterior aspect of the ulna or a fall on the outstretched
hand with the forearm in forced pronation. This fracture is associated with
an injury to the radial nerve. It is important to always look for an associated
fracture or dislocation when one is noted in a forearm bone.
A Galeazzi fracture (b)is a fracture of the distal radial shaft associated
with a distal radioulnar dislocation at the distal radioulnar joint (DRUJ).
This fracture is often confused with Monteggia fracture. A way to remem-
ber the difference is to recall that Monteggia ends in an “a” and in this frac-
ture, the ulna (also ends in “a”) is fractured. A Nightstick fracture (c)is an
isolated fracture of the shaft of the ulna. This injury can occur after a direct
blow to the ulna and usually occurs when an individual raises his or her
forearm up to protect their face from a blow. A Colles fracture (d)is a trans-
verse fracture of the metaphysis of the distal radius with dorsal displace-
ment of the distal fragment. The median nerve is at risk for injury. A Smith
fracture (e)is a transverse fracture of the distal radial metaphysis with volar