OR1.1-6 | Skeletal Trauma and Polytrauma Principles — Practice Quiz

Correct. ATLS primary survey begins with A (Airway with C-spine control), then B (Breathing), C (Circulation with haemorrhage control), D (Disability), and E (Exposure). The gurgling sounds indicate partial airway obstruction requiring immediate attention.

In ATLS, the primary survey follows the ABCDE sequence. Airway (with cervical spine control) is always the first priority regardless of other injuries, as airway obstruction causes death within minutes.

In ATLS, Airway management with C-spine control is always the first priority. Even active haemorrhage is addressed under 'C' — only after the airway is secured.

Correct. In START triage, absent radial pulse combined with altered consciousness and very high RR indicates a non-salvageable patient in a mass-casualty event — categorised Black (Expectant) to preserve resources for salvageable victims.

In START triage, a victim with absent radial pulse (no perfusion), RR >30/min, or failure to follow commands is categorised as Red (Immediate). However, absent breathing after airway repositioning or absent pulse indicates Black (Expectant/Dead) in a mass-casualty setting.

With absent radial pulses, RR of 36/min, and unresponsiveness to verbal commands, this patient meets criteria for Black (Expectant) in START mass-casualty triage — resource diversion to salvageable patients is the principle.

Correct. Class III shock: HR >120/min, BP decreased (systolic ~70–100 mmHg), RR 30–40/min, urine output 5–15 mL/hr, and altered mental status. A closed femoral fracture can lose 1.0–1.5 L of blood into the thigh.

ATLS classifies haemorrhagic shock into four classes. Class III (30–40% blood loss) presents with BP 70–100 mmHg systolic, pulse 120–140/min, RR 30–40/min, urine output 5–15 mL/hr, and confusion — matching this patient's parameters.

This patient's HR 136, BP 80/50, UO 12 mL/hr, and clammy skin indicate Class III haemorrhagic shock (30–40% blood loss). Remember a closed femoral fracture alone can cause 1–1.5 L of internal haemorrhage.

Correct. Gustilo-Anderson IIIB: wound >1 cm (or any size with extensive soft tissue damage), significant contamination, periosteal stripping/bone exposure, but NO arterial injury. Soft tissue coverage requires local or free flap.

Gustilo-Anderson Type IIIB is characterised by extensive soft tissue damage, periosteal stripping, and bone exposed with contamination, but no arterial injury. Type IIIC uniquely involves arterial injury requiring repair. Type II has a wound >1 cm with minimal soft tissue damage.

A 3 cm wound with extensive contamination but intact vasculature is Gustilo-Anderson Type IIIB. Remember: IIIC = arterial injury requiring repair; IIIA = adequate soft tissue coverage despite high energy; IIIB = inadequate soft tissue, requires flap coverage.

Correct. Acute compartment syndrome is a surgical emergency. The presence of a distal pulse does NOT exclude compartment syndrome — pulses are often preserved until very late. Pain on passive stretch is the earliest and most sensitive clinical sign. Fasciotomy should not be delayed.

Acute compartment syndrome diagnosis is clinical: pain out of proportion, pain on passive stretch, tense compartment. The threshold for fasciotomy is a compartment pressure within 30 mmHg of diastolic BP (ΔP <30 mmHg). Pulses are often PRESENT in compartment syndrome — waiting for pulse loss causes irreversible ischaemia.

Key OR known-trap: distal pulses are often PRESENT in acute compartment syndrome. Pain on passive stretch of fingers is the hallmark. Waiting for pulse loss leads to irreversible Volkmann's ischaemic contracture. Urgent fasciotomy is indicated when ΔP <30 mmHg.

Correct. Anterior shoulder dislocation most commonly injures the axillary nerve. Test: sensation over the 'regimental badge area' (lateral deltoid) and deltoid muscle contraction. Always document neurovascular status before reduction.

Anterior shoulder dislocation is the most common joint dislocation (95% of shoulder dislocations). The axillary nerve (C5, C6) is the most commonly injured nerve, causing deltoid weakness and a patch of anaesthesia over the 'regimental badge area' (lateral arm). This must be tested and documented before reduction.

OR known-trap: shoulder dislocation → axillary nerve injury. The axillary nerve winds around the surgical neck of humerus and is vulnerable to traction/compression in anterior dislocation.

Correct. Posterior hip dislocation puts the sciatic nerve (particularly its common peroneal component) at risk. Clinically: foot drop (weak dorsiflexion and eversion), sensory loss on dorsum of foot. Reduction should occur within 6 hours to reduce AVN risk.

Posterior hip dislocation classically results from dashboard injury — knee hits dashboard, force transmitted along femoral shaft. The sciatic nerve (especially the common peroneal division) is at risk, producing foot drop. Avascular necrosis of the femoral head is a late complication if reduction is delayed beyond 6 hours.

OR known-trap: posterior hip dislocation → sciatic nerve injury → foot drop. The posture of flexion, adduction, internal rotation with shortening is pathognomonic of posterior hip dislocation.

Correct. Negative Pressure Wound Therapy (NPWT/VAC) is a major recent advance in open fracture and post-fasciotomy wound management. It promotes healing, reduces bacterial colonisation, and simplifies wound care between debridements.

Negative Pressure Wound Therapy (NPWT/VAC therapy) is a key recent advance that bridges temporary wound closure after fasciotomy or debridement and definitive flap reconstruction. It reduces bacterial load, promotes granulation tissue, reduces oedema, and decreases the need for primary flaps in open fractures.

VAC/NPWT therapy is a key recent advance (OR1.6) in open fracture and compartment syndrome aftercare. It is now preferred over conventional wet-to-dry dressings for temporary wound management after debridement.