Trauma
Core concepts
Trauma questions test the ABCs of damage control and definitive fixation. Master the ATLS approach: airway, breathing, circulation, disability, exposure, and the secondary survey. Know the classification and management of open fractures (Gustilo-Anderson) and the timing of debridement and antibiotics. Understand pelvic and acetabular fractures: the ring concept, the role of external fixation, and the risk of hemorrhage. Review long bone fractures and the indications for intramedullary nailing versus plating, and the principles of articular fracture reduction. Know compartment syndrome: the 5 Ps, the role of compartment pressures, and emergent fasciotomy. Also cover the polytrauma patient and damage-control orthopaedics.
Traps
The classic trap is missing compartment syndrome in a patient with a fracture and pain out of proportion; do not wait for pulselessness. Another is underestimating open fractures; antibiotics and debridement are time-sensitive. Examiners also test that pelvic fractures can cause massive hemorrhage and that an unstable pelvis needs stabilization.
Rule of thumb
Pain out of proportion and pain with passive stretch are the earliest signs of compartment syndrome; fasciotomy is the treatment, not observation.
Worked example
A 30-year-old with a tibial shaft fracture, severe pain, and a tense compartment: measure compartment pressures; if elevated, perform emergent fasciotomy to prevent necrosis.