Bone Or Joint Injury
Welcome to this comprehensive MCCQE1 study resource on bone and joint injuries. This guide is tailored specifically for Canadian medical students preparing for the Medical Council of Canada Qualifying Examination Part I (MCCQE1). We'll cover key concepts, Canadian guidelines, and provide practice questions to help you excel in your exam.
Types of Bone Injuries
Understanding the various types of bone injuries is crucial for MCCQE1 preparation. Here are the main categories:
- Simple fractures: Bone breaks without skin penetration
- Compound fractures: Bone breaks with skin penetration
- Comminuted fractures: Bone shatters into multiple pieces
- Greenstick fractures: Incomplete fracture, common in children
Canadian Epidemiology of Bone Injuries
In Canada, the most common bone injuries vary by age group:
| Age Group | Most Common Bone Injury |
|---|---|
| Children | Forearm fractures |
| Adults | Hip fractures |
| Elderly | Vertebral fractures |
Assessment and Diagnosis
Proper assessment and diagnosis of bone and joint injuries are crucial skills tested in the MCCQE1. Follow these steps:
History Taking
- Mechanism of injury
- Timing and onset of symptoms
- Associated symptoms
- Past medical history
Physical Examination
- Inspection for deformity, swelling, or bruising
- Palpation for tenderness and crepitus
- Range of motion assessment
- Neurovascular examination
Imaging Studies
- X-rays: First-line for most suspected fractures
- CT scans: For complex fractures or when X-rays are inconclusive
- MRI: For soft tissue injuries and occult fractures
- Bone scans: For stress fractures or metastatic disease
Canadian Guidelines
The Canadian Orthopaedic Association provides guidelines for managing various bone and joint injuries. Key points include:
- Early mobilization for most fractures to prevent complications
- Use of thromboprophylaxis in high-risk patients
- Multidisciplinary approach involving physiotherapists and occupational therapists
The Canadian Orthopaedic Trauma Society (COTS) conducts ongoing research to improve fracture care in Canada. Stay updated with their latest guidelines for MCCQE1 preparation.
Sample MCCQE1 Question
A 68-year-old woman presents to the emergency department after a fall on an icy sidewalk in Toronto. She complains of right hip pain and is unable to bear weight. On examination, her right leg appears shortened and externally rotated. Which one of the following is the most appropriate next step in management?
- A. Order a CT scan of the hip
- B. Perform closed reduction under sedation
- C. Arrange for immediate orthopedic consultation
- D. Order plain radiographs of the pelvis and hip
- E. Start the patient on low molecular weight heparin
Explanation
The correct answer is:
- D. Order plain radiographs of the pelvis and hip
This patient's presentation is highly suggestive of a hip fracture, which is common in elderly patients after falls, especially in Canadian winters. The shortened and externally rotated leg are classic signs. The most appropriate next step is to confirm the diagnosis with plain radiographs of the pelvis and hip. This is in line with Canadian guidelines for initial assessment of suspected hip fractures.
Option A (CT scan) is not the first-line imaging for suspected hip fractures. Option B (closed reduction) would be inappropriate before confirming the diagnosis and type of fracture. Option C (immediate orthopedic consultation) may be necessary, but not before obtaining imaging. Option E (starting LMWH) may be part of the management plan, but is not the immediate next step.
Remember, for the MCCQE1, always consider the most appropriate next step in the Canadian healthcare context, which often emphasizes efficient use of resources and evidence-based practice.
References
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Canadian Orthopaedic Association. (2021). Clinical Practice Guidelines. https://coa-aco.org/clinical-practice-guidelines/ (opens in a new tab)
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Canadian Institute for Health Information. (2020). Injury and Trauma Emergency Department and Hospitalization Statistics. https://www.cihi.ca/en/injury-and-trauma-emergency-department-and-hospitalization-statistics (opens in a new tab)
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Stiell, I. G., et al. (1992). Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA, 269(9), 1127-1132.
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Canadian Orthopaedic Trauma Society. (2021). Research Publications. https://cots.org/publications/ (opens in a new tab)
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Papaioannou, A., et al. (2015). Clinical practice guidelines for the assessment and management of osteoporosis in Canada: a review. CMAJ, 187(15), 1143-1149.