Musculoskeletal Injuries Answers 343displacement of the distal fragment. As in a Colles fracture, the median
nerve is at risk for injury.
317.The answer is a.(Omori, 2007.)The patient has a herpetic whitlow,
a viral infection of the distal finger. It is caused by the herpes simplex virus
type I or II. This condition typically occurs in health-care providers with
exposure to oral secretions, and in patients with coexistent herpes infec-
tions. It generally presents with a prodrome period of fever and malaise.
Subsequently, there is localized burning, itching and pain that precede the
development of the classic clear herpetic vesicles. Typically, only one finger
is involved. The diagnosis is usually made clinically, but if doubt remains,
or if the presentation is atypical, it can be confirmed with a Tzanck smear
or viral culture. When managing this condition, it is important to note that
surgical drainage is contraindicated.It can result in secondary infection
and delayed healing.
All of the other answer choices (b, c, d, and e)are acceptable man-
agement options.
318.The answer is a.(Simon and Koenigsknecht, p 191.)Flexor tenosyn-
ovitistypically results from a puncture wound. The causative agents are
usuallyStaphylococcus aureusorStreptococcus.The diagnosis is based on the
presence of Kanavel four cardinal signsof flexor tendon synovitis. These
include the finger held in slight flexion at rest, (b)symmetric swelling or
sausage digit of the finger, (c)tenderness along the flexor tendon sheath,
and(d)pain with passive range of motion of the finger. Answer choice
(e)is not one of Kanavel signs.
319.The answer is c.(Richards, 2007.)TheOttawa rulesare a prospec-
tively validated clinical decision tree for radiograph ordering in adults. By
following these rules, emergency physicians can eliminate up to 30% of
radiographs that are routinely ordered without missing clinically signifi-
cant fractures. Radiographs are only required if there is bony pain in the
malleolar or midfoot area, and any one of the following: bony tenderness at
the navicular bone or at the base of the fifth metatarsal; (a)bony tender-
ness is present at the posterior edge of the distal 6 cm or at the tip of either
malleolus, and (b)the patient is unable to bear weight for at least four steps
immediately after the injury and at the time of evaluation. A diminished
Achilles reflex (d)or effusion (e)are not part of the Ottawa criteria.