Return to Scenario ListShow Learning Points most relevant to Phase 1:

Forearm / wrist injury

Clinical Discipline(s)/Organ System(s)
Musculoskeletal System, Orthopaedics
Progress Test Topic(s)
Musculoskeletal
Description
A 24 year old male Māori forestry worker presents with severe and worsening left forearm and wrist pain after crushing his forearm between two heavy logs of wood at work. An X-ray shows comminuted mid-shaft fractures of the radius and ulna. He develops compartment syndrome. This is not diagnosed immediately and despite surgical decompression he goes on to suffer serious disability.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the elbow, forearm and wrist
   - Common fractures of forearm and wrist
   - Pathophysiology of compartment syndrome
   - Healing processes for bones and joints
Clinical and Communication Skills 
   - History of a musculoskeletal trauma
   - Perform neurovascular assessment of periphery and examination of the joints of the upper limb
   - Interpretation of X-rays of the wrist and forearm and identify common fracture patterns
   - Recognise the features of compartment syndrome and outline its management
   - Indications for urgent fasciotomy and effects of delay in treatment
Personal and Professional Skills 
   - Appropriateness of prompt analgesia prior to detailed history and examination
   - Recognition that ongoing severe pain requires immediate review
   - Open disclosure and apology in the event of medical error
   - The role of ACC, Health and Disability Commissioner and NZ Medical Council in medical misadventure claims
Hauora Māori 
   - ACC evidence of reduced delivery of care for Māori
   - Root causes of educational disparities that result in Māori being more likely to be employed in occupational groups with a higher incidence of work-related injury (manual labour, machine operating, agriculture, fisheries)
Population Health 
   - Workplace accidents; the role of the Department of Health and Safety and ACC
   - Societal costs of injuries and associated long-term disability
   - Preventive strategies for work-related injuries
Conditions to be considered relating to this scenario
Common
wrist and forearm fractures, soft tissue injuries of extremities, compartment syndrome, compound fractures, neurovascular injury to extremities
Less common but 'important not to miss'
compartment syndrome in crush injuries without fracture, gas gangrene