Rosh Emergency Medicine Practice Test

What is the most appropriate management plan for a patient with significant left wrist pain and a deformity after falling?

1. Reduction, placement in removable wrist splint, follow-up with orthopedics in 2-3 days

2. Reduction, placement in short arm cast, admission for orthopedic management

3. Reduction, placement of dorsal wrist splint, admission for orthopedic management

4. Reduction, placement of molded sugar tong splint, follow-up with orthopedics in 2-3 days

The correct answer is: Reduction, placement of molded sugar tong splint, follow-up with orthopedics in 2-3 days

The most appropriate management plan involves performing a reduction of the wrist injury followed by the application of a molded sugar tong splint and scheduling a follow-up with orthopedics in 2-3 days. A molded sugar tong splint is effective in providing stable immobilization of the wrist while allowing for some degree of swelling and management of pain. It encompasses both the palm and forearm, providing support and preventing excessive motion that could lead to further injury. This type of splint is particularly useful for managing fractures or severe sprains as it can help maintain alignment without applying excessive pressure. In addition, scheduling a follow-up with orthopedic specialists in a short time frame is essential for comprehensive care, as they will assess the need for potential surgical intervention or further imaging studies. This option balances the need for immediate stabilization and ongoing evaluation, which is crucial in cases where significant deformity is observed following trauma. Other management strategies, such as those involving a short arm cast or admission for orthopedic management, may not be necessary in the initial evaluation unless there are signs of complications such as vascular compromise or open fractures. The case presented supports conservative management with timely follow-up, making this choice the most appropriate.