I85PREP
⌘ K
Arab Board Orthopedic Surgery Clinical study materials
Arab Board Orthopedic Surgery Clinical study resources

Arab Board Orthopedic Surgery Clinical: Trauma and Fracture Management

Arab Board Orthopedic Surgery Clinical · Work through your exam, one topic at a time.

All guide sections

Trauma and Fracture Management

Principles of Fracture Management

Candidates must master the ATLS approach (ABCDE) and the concept of damage control orthopedics (DCO) versus early total care (ETC). Understand the mechanism of injury, fracture pattern (e.g., spiral, comminuted, segmental), and soft tissue assessment (Tscherne classification for closed fractures, Gustilo-Anderson for open fractures). Know the indications for nonoperative vs operative treatment, including relative stability (bridge plating, external fixation) vs absolute stability (compression plating, lag screws).

Key Concepts

  • Open fracture management: antibiotics within 1 hour, tetanus prophylaxis, urgent debridement (within 24 hours, but timing debated), and stabilization. Gustilo-Anderson classification guides treatment: Type I-II (low energy) vs III (high energy, with IIIA (adequate soft tissue coverage), IIIB (requires flap), IIIC (vascular injury requiring repair)).
  • Compartment syndrome: early recognition (pain out of proportion, pain on passive stretch, paresthesia), measurement of compartment pressures (delta pressure <30 mmHg indicates fasciotomy).
  • Fracture healing: primary (direct) healing with absolute stability (no callus) vs secondary (indirect) healing with relative stability (callus formation).
  • Polytrauma: DCO with temporary external fixation to avoid second hit (systemic inflammatory response).

Traps

  • Timing of debridement: Questions may ask about the acceptable delay; evidence supports debridement within 24 hours, but not necessarily immediate for all.
  • Antibiotic choice: For Gustilo III, add penicillin for anaerobic coverage (e.g., farm injuries).
  • Fasciotomy: Perform full-length fasciotomy (not just skin incision) and avoid closing primarily.
  • Fracture blisters: Delay surgery until resolved to reduce infection risk.

Worked Example

A 35-year-old male with a closed tibial shaft fracture after a motorcycle accident. He has severe pain, tense compartment, and pain on passive toe extension. Compartment pressure is 40 mmHg, diastolic BP 70 mmHg. Delta pressure = 30 mmHg. Rule of thumb: Delta pressure <30 mmHg is an indication for fasciotomy. Here, delta pressure is 30, so borderline; but with clinical signs, fasciotomy is indicated. Immediate fasciotomy and fracture stabilization (e.g., external fixator) are performed.