Falling on outstretched hands/arms/wrists...

Discussion in 'Step I' started by whitcoatsyndrom, May 18, 2014.

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  1. whitcoatsyndrom

    whitcoatsyndrom 2+ Year Member

    Mar 13, 2011
    Is there any trend on whether the question (uworld in particular) implies falling forward or backward. It makes a difference in regards to locations of shoulder injuries and some of these questions dont seem to specify direction...am i missing something?
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  3. Ionian

    Ionian 2+ Year Member

    Nov 22, 2013
    You just have to base your decision on the symptoms presented.

    Falling on a outstretched hand doesn't seem to be specific to any one thing.

    I believe I've see the answer to "falling on an outstretched hand" = Colles fracture, Mid-shaft fracture, shoulder dislocation, and I think maybe clavicle fracture too?
    notbobtrustme and dyspareunia like this.
  4. dyspareunia


    Mar 6, 2014
    And scaphoid.
    Ionian likes this.
  5. Lavan

    Lavan 2+ Year Member

    Jan 6, 2014
    The shoulder dislocation will always be anterior on Step-type questions unless the patient is having a seizure or has been hit by lightening (in which case it can be posterior). Fall on outstretched hand questions, at least from my memory, more often involved the hand (scaphoid fracture, lunate dislocation) more than the arm, and I would definitely know those facts as being the "most common" injuries. Anything else I'd think they'd have to provide you additional clinical information.
  6. thehundredthone

    thehundredthone 5+ Year Member

    Aug 20, 2012
    There is a rough rule of thumb from hearsay, based on age: children = clavicle, adults = scaphoid, elderly = Colles.
  7. Diggidy

    Diggidy 7+ Year Member

    Jan 20, 2009
    Anecdotally, I know from years of racing downhill mountain bikes that it definitely can fracture your clavicle, as it happens all the time with guys going over their handle bars and throwing their arms out to protect their fall. Colle's fracture is also very common.

    Is this really important for Step 1 though? It seems like fractures are only important if their associated with a possible neuro deficit so they can ask you which nerve/artery/vein is liekly damaged. I've not seen any questions that just say "so and so feel onto X extremity in Y position -- which bone did they fracture?"
  8. dyspareunia


    Mar 6, 2014
    From a qbank: Patient falls on outstretched hand and has some minor swelling, minor pain near wrist, but nothing severe. Normal X-ray. Most common complication?

    --> Avascular necrosis secondary to scaphoid fracture. Snuffbox would've been a dead giveaway, but it was not mentioned.

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