Trauma and Fracture Management
What you must understand
Master the ATLS sequence and damage-control orthopedics: hemorrhage control, resuscitation, and staged fixation in polytrauma. Know fracture classification systems commonly tested - AO/OTA, Gustilo–Anderson for open fractures, Salter–Harris for physeal injuries, and Neer for proximal humerus. Understand principles of nonoperative versus operative treatment, timing of fixation, and the biology of soft-tissue envelope. Be fluent in complications: nonunion, malunion, infection, fat embolism, and post-traumatic arthritis.
Traps in questions
- Gustilo grading hinges on wound size, contamination, and soft-tissue injury - a high-energy 1 cm wound is still type III.
- Open fractures need antibiotics within one hour and tetanus prophylaxis; debridement timing is debated but early irrigation and debridement remains standard.
- Compartment syndrome after tibial shaft fracture is the classic missed diagnosis - pain with passive stretch is the earliest reliable sign.
- Fat embolism syndrome presents 24–72 hours post-injury with hypoxia, petechiae, and confusion - not immediately.
Worked example
A 35-year-old with a closed femoral shaft fracture and hemodynamic instability: treat as damage control - temporary external fixation or traction, resuscitate, then definitive intramedullary nailing when physiology permits. Early total care is reserved for stable patients.
Exam strategy
For each fracture, ask: is the soft tissue the problem, is the patient physiologically stable, and what is the goal of fixation (absolute versus relative stability)?