Musculoskeletal and Soft Tissue Emergencies
This domain tests fracture and dislocation management, compartment syndrome, open fractures, septic arthritis, and necrotising soft tissue infection. The exam emphasises neurovascular examination before and after procedures.
Core rules
- Assess distal pulses, sensation, and motor function before and after reduction or splinting.
- Compartment syndrome is clinical: pain out of proportion, pain on passive stretch, tense compartment. Do not wait for pulselessness.
- Open fractures need early antibiotics, tetanus assessment, wound coverage, and urgent orthopaedic review.
- Knee dislocation may injure the popliteal artery; document pulses and consider urgent vascular imaging.
- Necrotising fasciitis requires urgent surgical debridement and broad-spectrum antibiotics; imaging must not delay surgery.
Worked example
A patient with an anterior shoulder dislocation has numbness over the lateral deltoid. Document axillary nerve function, reduce with analgesia and muscle relaxation, then re-examine neurovascular status and obtain post-reduction imaging.
Traps
- Do not reduce a suspected fracture-dislocation without checking distal neurovascular status.
- Do not attribute severe pain only to fracture; consider compartment syndrome.
- Do not give oral antibiotics and discharge an open fracture.
- Do not delay debridement for necrotising fasciitis awaiting MRI.