Orthopaedic Surgery and Traumatology
What the exam tests
This domain tests fracture assessment, open fracture management, compartment syndrome, hip fracture care and common paediatric orthopaedic problems.
Core rules
- Assess neurovascular status before and after any reduction or splinting and document it.
- Open fractures require urgent antibiotics, tetanus assessment, wound cover and debridement; Gustilo-Anderson grading guides fixation and soft-tissue management.
- Compartment syndrome is suggested by pain out of proportion, pain on passive stretch and a tense compartment; pulselessness is late. Urgent fasciotomy is required.
- Hip fracture surgery should not be delayed unnecessarily; aim for surgery within 36 hours in fit patients after optimisation.
- A normal X-ray does not exclude a scaphoid fracture; immobilise and repeat imaging or use early MRI.
Worked example
An 80-year-old falls and cannot weight-bear. The leg is shortened and externally rotated. Analgesia and neurovascular assessment are performed, and X-ray confirms a displaced intracapsular femoral neck fracture. After medical optimisation, VTE prophylaxis and antibiotic prophylaxis, he undergoes arthroplasty according to local protocol and is mobilised early.
Traps
Failing to document distal pulses and sensation; missing a second injury; assuming a normal radiograph excludes scaphoid fracture; and missing compartment syndrome because a pulse is present.