Fracture Management and Traumatic Injuries
Domain 3: Fracture Management and Traumatic Injuries
This domain tests systematic fracture description, initial stabilization, and recognition of limb-threatening complications.
Core rules
- Describe every fracture: bone, location (proximal/mid/distal, intra-articular), pattern (transverse, oblique, spiral, comminuted, segmental), displacement, angulation, shortening, rotation, and open vs closed.
- Assess skin integrity, distal pulses, capillary refill, sensation, and motor function before and after any reduction, splint, or cast.
- Splint to immobilize the joint above and below the fracture; pad bony prominences; avoid circumferential casts in acute swelling.
- Open fractures: administer IV antibiotics and tetanus prophylaxis promptly, cover the wound, splint, and arrange urgent irrigation and debridement.
- Compartment syndrome is a clinical diagnosis: pain out of proportion, pain with passive stretch, tense compartment, paresthesia; pulses may remain normal. Remove constricting casts and call for emergent fasciotomy.
- Healing phases: inflammation, repair (callus), remodeling. Complications include nonunion, malunion, avascular necrosis, complex regional pain syndrome, and fat embolism.
Worked example
A 28-year-old has an open distal tibia fracture after a motorcycle crash. Give IV cefazolin plus gentamicin per protocol, update tetanus, cover with sterile saline dressing, splint, document distal neurovascular exam, and arrange urgent debridement and fixation. Do not close the wound in the emergency department.
Traps
Documenting pulses only after splinting; waiting for pallor or pulselessness to diagnose compartment syndrome; and missing an open fracture through a small puncture wound.