Trauma and Fracture Management
Core rules
- ATLS sequence starts with catastrophic haemorrhage control, airway, breathing and circulation; orthopaedic injury is managed within the primary survey when it threatens life or limb.
- Damage control orthopaedics uses temporary stabilization, haemorrhage control and warming in physiologically unstable polytrauma, delaying definitive fixation until resuscitation endpoints improve.
- Open fractures need early intravenous antibiotics, tetanus assessment, debridement and stabilization; Gustilo–Anderson grade guides soft-tissue urgency, not antibiotic choice alone.
- Compartment syndrome is clinical: pain out of proportion, pain on passive stretch and tense compartment; pulselessness is late. Fasciotomy is urgent.
- Pelvic ring injuries can exsanguinate; a binder and early angioembolization or preperitoneal packing may be needed.
Worked example
A 34-year-old motorcyclist arrives hypotensive with an open tibial shaft fracture and a stable pelvis on plain film. Reasoning: control external bleeding, give antibiotics and tetanus prophylaxis, apply a splint, activate massive transfusion if indicated, and perform temporary external fixation because Physiology dominates over anatomy. Definitive intramedullary nailing waits until perfusion and coagulation improve.
Traps
Do not rely on a single pressure measurement to exclude compartment syndrome. Do not delay antibiotics for culture. Do not miss associated knee or ankle injury in a tibial fracture.
Key points are listed separately.