GC231 High Energy Trauma Open Fracture: Part 1
An open fracture resulting from high-energy mechanisms (e.g., motor vehicle accidents, falls from height) in which bone is exposed through a wound, carrying significant risk of contamination, soft tissue damage, and complications requiring urgent surgical management.
High Energy Trauma & Open Fracture – Part 1
Lecture Map
This lecture by Professor Frankie Leung (Tam Sai-Kit Professor in Orthopaedics and Traumatology) covers the orthopaedic approach to polytrauma and high-energy injuries. It sits at the intersection of Emergency Medicine, Orthopaedics, and Critical Care — a guaranteed exam topic because it involves life-and-death decision-making, clear algorithmic thinking, and several classic "one-best-answer" MCQ discriminators [1].
1. Understand the principles of management of polytrauma patients 2. Understand the acute management of pelvic injuries 3. Understand the principles of management of open fractures 4. Learn the patho-mechanism of compartment syndrome and its management
Part 1 focuses heavily on objectives 1 and 2 (polytrauma management + pelvic fractures). Open fractures and compartment syndrome are expanded in Parts 2 and 3 but are introduced here.
The Fourth Summative repeatedly tests: ATLS sequencing, pelvic fracture haemorrhage control (external fixation vs embolisation — directly tested in 2025 MCQ Q45), crush injury management, trimodal death pattern, and fracture prioritisation. This lecture provides the surgical/orthopaedic perspective that complements the anaesthesia/critical-care and radiology lectures.
Core Concepts and Mechanisms
Trimodal pattern of death after multiple trauma:
- Death within minutes — airway injury, severe head or chest injuries
- Death within hours — haemorrhage, head or chest injuries
- Death within days — multi-organ failure, DIC, sepsis [1]
Why this matters from first principles:
| Peak | Timing | Pathophysiology | Implication |
|---|---|---|---|
| 1st peak | Seconds to minutes | Lethal injuries incompatible with life (e.g. aortic rupture, massive brain laceration, high cervical cord transection) | Prevention is the only intervention (seatbelts, airbags, helmets) |
| 2nd peak | Minutes to hours ("golden hour") | Ongoing haemorrhage (splenic rupture, pelvic fracture, haemothorax), expanding intracranial haematomas, tension pneumothorax | This is where ATLS and surgical intervention save lives — the entire lecture targets this window |
| 3rd peak | Days to weeks | Systemic inflammatory response → ARDS, MODS, DIC, sepsis | Prevented by early fracture stabilisation, damage-control surgery, ICU care |
The lecture's entire framework is designed to intervene during the second peak and prevent the third peak.
Save Life → Save Limb → Save Function [1]
This hierarchy is critical because students often jump to thinking about fracture fixation before addressing life-threatening issues. Every decision in trauma follows this order.
Life-threatening orthopaedic injuries:
- Haemorrhage
- Major crush injury
- Proximal amputation
- Multiple fractures [1]
Why these are life-threatening:
- Haemorrhage: A closed femoral shaft fracture can lose 1–1.5L of blood into the thigh; a pelvic fracture can lose the entire circulating volume into the retroperitoneal space. Haemorrhagic shock is the number one preventable cause of death in the second peak.
- Major crush injury: When large muscle mass is crushed (e.g. trapped under rubble), rhabdomyolysis releases myoglobin, potassium, and phosphate. Upon extrication, reperfusion syndrome can cause fatal hyperkalaemia and cardiac arrest (directly tested in 2017 SAQ Q9) [6].
- Proximal amputation: Traumatic above-knee or above-elbow amputation involves major named vessels → massive haemorrhage.
- Multiple fractures: Each fracture is a source of blood loss, fat embolism, and systemic inflammation. The cumulative "second hit" of surgical fixation can push a borderline patient into MODS.
Non-orthopaedic life-threatening injuries (implied by the slide listing them separately): head injury, chest injury (tension pneumo, haemothorax, cardiac tamponade), abdominal injury (splenic/hepatic laceration), aortic injury [1].
Limb-threatening injuries:
- Vascular injury
- Compartment syndrome
- Dislocation of major joints
- Open fractures [1]
Why each threatens the limb:
| Injury | Mechanism of Limb Loss | Time Window |
|---|---|---|
| Vascular injury | Loss of arterial inflow → ischaemia → irreversible muscle necrosis | 6 hours of warm ischaemia before irreversible damage |
| Compartment syndrome | Raised pressure in closed fascial compartment → capillary perfusion pressure exceeded → muscle and nerve necrosis | 6 hours — fasciotomy is the only definitive treatment |
| Dislocation of major joints | Knee dislocation has ~40% incidence of popliteal artery injury; hip dislocation risks AVN of femoral head | Reduction within hours |
| Open fractures | Contamination + devascularised tissue → infection → osteomyelitis → potentially amputation | Debridement ideally within 6–8 hours (see Part 2) [2][3] |
Exam Discriminator
The distinction between life-threatening and limb-threatening injuries is a favourite exam question. Haemorrhage is life-threatening; compartment syndrome is limb-threatening. A pelvic fracture can be BOTH (life-threatening from haemorrhage + limb-threatening if vascular injury extends to limb vessels).
Resuscitation — ATLS protocol:
- A: Airway with cervical spine control
- B: Breathing
- C: Circulation
- D: Disability & Neurological status
- E: Exposure & Environment [1]
Why This Order?
The order is based on what kills the patient fastest:
- A kills in seconds (complete airway obstruction → no oxygen to brain → death in 3–5 minutes)
- B kills in minutes (tension pneumothorax → obstructive shock; massive haemothorax → hypovolaemia + respiratory failure)
- C kills in minutes to hours (uncontrolled haemorrhage)
- D identifies conditions that may require immediate neurosurgical intervention (expanding intracranial haematoma)
- E prevents missed injuries (log-roll to check spine, perineum) and prevents hypothermia (which worsens coagulopathy in the "lethal triad" of trauma: hypothermia + acidosis + coagulopathy)
Cervical spine control is paired with airway because the mechanism that causes airway injury (high-energy blunt trauma) is the same mechanism that causes cervical spine injury. Moving the neck during intubation without C-spine control can convert an incomplete cord injury to a complete one.
Trauma series:
- CXR — AP
- Pelvis XR — AP
- Cervical spine — lateral [1]
Why these three specific films?
| Film | What It Detects | Why It's Critical |
|---|---|---|
| CXR (AP) | Pneumothorax, haemothorax, widened mediastinum (aortic injury), ruptured diaphragm, rib fractures | Chest injuries are the second commonest cause of trauma death |
| Pelvis XR (AP) | Pelvic ring disruption | Pelvic fractures can cause massive retroperitoneal haemorrhage — early identification changes management immediately |
| C-spine (lateral) | Cervical fractures/dislocations | Must visualise C7–T1 junction (Clay-Shoveller's fracture) [4] |
Modern Practice Note
In many modern trauma centres, a pan-scan CT (CT head, C-spine, chest, abdomen, pelvis with contrast) has largely replaced the trauma series for haemodynamically stable patients. However, for unstable patients, plain films are still first-line because they can be done in the resuscitation bay without moving the patient. The lecture teaches the classic trauma series — this is the exam-expected answer [1][3].
Priorities in management of multiple fractures:
- Open fractures with significant bleeding
- Unstable pelvic fractures
- Spinal fractures
- Femoral shaft fractures
- Other long bone fractures [1]
Why this order?
- Open fractures with significant bleeding — direct haemorrhage + contamination risk; both life- and limb-threatening
- Unstable pelvic fractures — can lose entire blood volume into retroperitoneum; requires emergent stabilisation
- Spinal fractures — unstable spine → risk of cord injury with any movement; early stabilisation protects the cord
- Femoral shaft fractures — each femur can lose 1–1.5L blood; early fixation reduces fat embolism and ARDS
- Other long bone fractures — each humerus ~0.5L, each tibia ~0.5L; cumulative blood loss is significant
Early fracture stabilisation:
- Reduces ARDS
- Facilitates early rehabilitation
- Facilitates nursing care
- Reduces length of ICU stay
- Reduces pain [1]
From first principles — why does stabilising fractures reduce ARDS?
Unstabilised long bone fractures → ongoing movement at fracture site → continued release of:
- Fat globules from marrow cavity → fat embolism syndrome → ARDS
- Inflammatory mediators (tissue factor, cytokines) → systemic inflammatory response → MODS
- Ongoing blood loss → need for more transfusions → transfusion-related lung injury (TRALI)
Early fixation (especially of femoral shaft fractures within 24 hours) has been shown to reduce pulmonary complications from ~20% to ~5% in polytrauma patients. This is one of the most important evidence-based principles in orthopaedic trauma.
High Yield Concept
Early fracture stabilisation reduces ARDS — this is a direct lecture point and a common exam answer when asked "Why is early fixation of femoral shaft fractures important in polytrauma?" [1]
Pelvic Fractures — Detailed Management
This is the centrepiece clinical scenario of Part 1. Pelvic fractures are tested almost every year.
The pelvis is a bony ring — if it breaks in one place, it almost always breaks in another (or a joint disrupts). The pelvis contains:
- Large venous plexuses (presacral, internal iliac) — low-pressure bleeding that is difficult to control surgically
- Major arteries (internal iliac branches) — high-pressure bleeding
- Large potential retroperitoneal space — can accommodate the entire circulating blood volume without external signs
Step-by-Step Management of Pelvic Fracture Haemorrhage
Control bleeding in pelvic fracture:
Detailed explanation of each step:
- Applied pre-hospital or in the resuscitation bay
- A circumferential compression device placed at the level of the greater trochanters (not the iliac crests — this is a common error)
- Works by reducing the volume of the disrupted pelvic ring → bringing bone fragments closer together → reducing the space available for haemorrhage
- Only temporary because:
- Prolonged compression → pressure necrosis of skin
- Does not provide definitive stabilisation
- Cannot be tightened enough to achieve long-term fixation
This is the definitive initial orthopaedic intervention for unstable pelvic fractures with haemodynamic instability.
Why external fixation works — three mechanisms:
- Reduces pelvic volume by up to 35% — closing the "open book" of the disrupted pelvis reduces the container into which blood can accumulate
- Tamponade effect — the reduced volume allows the retroperitoneal haematoma to compress against itself, creating a natural tamponade that slows venous bleeding
- Reduces micromotion and shearing — unstabilised fracture fragments constantly disrupt forming clots; fixation allows haemostasis
The lecture states external fixation is MANDATORY [1]
THE Classic MCQ Question
Q: A patient sustained pelvic fracture and unstable BP despite resuscitation in emergency room. Which is the most appropriate next step? A. External fixation ✓ B. Direct pressure on bleeding site C. Get urgent CT scan D. Arterial embolisation E. Open exploration and tying of bleeding vessel
Answer: A. External fixation — This is directly from the lecture slides [1]. The key discriminator: the patient is haemodynamically unstable despite resuscitation. You cannot send an unstable patient to CT (C is wrong). Embolisation (D) is a secondary measure — you do it after ex-fix if bleeding continues. Open exploration (E) is almost never done for pelvic venous bleeding because you lose the tamponade effect. Direct pressure (B) doesn't work for deep retroperitoneal bleeding.
This exact question appeared in the 2025 Fourth Summative MCQ Q45 [9].
If bleeding continues despite external fixation:
| Measure | When to Use | How It Works |
|---|---|---|
| Angiographic embolisation | Arterial bleeding (contrast blush on CT angiogram) | Interventional radiology selectively embolises bleeding branches of internal iliac artery |
| Pelvic packing | Venous bleeding, or when angiography is unavailable | Direct placement of packs into the retroperitoneal space through a small incision to provide mechanical tamponade |
Clinical pearl: Most pelvic fracture bleeding is venous (from presacral plexus and cancellous bone surfaces). Arterial bleeding occurs in only ~10–15% of cases but is the cause of exsanguination in those who fail external fixation. This is why embolisation is a secondary measure — it addresses the minority of cases with arterial bleeding.
The Polytrauma Case Discussion
The lecture presents a detailed case that walks through the entire management algorithm [1]:
Vitals unstable — temp 36°C, BP 90 systolic, resp rate 30/min, unconscious Injuries: Ruptured diaphragm, unstable type C pelvic fracture, open L tibia, R pilon fracture, closed L distal femur, R humerus fractures FAST confirms ruptured spleen and diaphragm CT head and CT pelvis with contrast obtained [1]
Phase-by-Phase Management (Damage Control Orthopaedics)
This case beautifully illustrates the concept of Damage Control Orthopaedics (DCO) — the principle that in a severely injured, physiologically compromised patient, you do the minimum necessary surgery to save life and limb in the primary phase, then return for definitive fixation once the patient is stabilised.
1. Repair of ruptured diaphragm and splenectomy (save life — address abdominal catastrophe) 2. Fluid resuscitation (ongoing) 3. Debridement of open wounds (prevent infection — limb-saving) 4. External fixation of pelvis (control pelvic haemorrhage — life-saving) [1]
Why this order?
- Ruptured diaphragm + ruptured spleen = two life threats that need immediate surgery
- Open wound debridement addresses contamination (clock is ticking for infection)
- Ex-fix of pelvis controls the other major source of blood loss
Then: Spanning fixators of L femur and R pilon + IMN of open L tibia [1]
Why spanning fixators (not definitive fixation)?
- The patient is too sick for prolonged surgery — "fix and run"
- Spanning external fixators temporarily stabilise the fracture, reduce blood loss, and prevent fat embolism
- IMN (intramedullary nail) of the open tibia is acceptable because it can be done relatively quickly and provides good stabilisation
PO Day 3: Repeat I&D wounds and ORIF L femur PO Day 7: ORIF R pelvis and ORIF humerus PO Day 11: ORIF pilon [1]
Why staged like this?
- Day 3: Patient has been resuscitated, coagulopathy corrected, core temperature normalised. Femur fixation is prioritised (major blood loss source, reduces fat embolism risk)
- Day 7: Patient is more stable; pelvis definitive fixation and humerus ORIF
- Day 11: Pilon (distal tibia articular fracture) is done last because it requires meticulous articular reduction but is not as physiologically demanding as the others
- Wounds are re-debrided (I&D = irrigation and debridement) before each stage to ensure no infection
Damage Control Orthopaedics Principle
In the physiologically compromised polytrauma patient: stabilise, don't definitively fix. Temporary external fixation → ICU resuscitation → staged definitive fixation over days to weeks. This prevents the "second hit" of prolonged surgery that can push the patient into MODS [1].
The lecture poses this question on a slide [1]. The key criteria for a successful external fixation of the pelvis:
- Haemodynamic improvement — BP stabilises or improves after application
- Adequate reduction — pelvic ring is reduced enough to decrease volume and achieve tamponade
- Stable construct — pins are secure in bone, frame does not loosen
- No iatrogenic injury — pins placed safely away from neurovascular structures
If ex-fix does not achieve haemodynamic improvement → proceed to secondary measures (embolisation/packing).
"Injury to the soft tissues is the most important component of high-energy trauma. Zone of injury always beyond fracture site." [2]
This is a foundational concept: in high-energy trauma, the visible fracture is just the tip of the iceberg. The surrounding soft tissue (muscle, fascia, vessels, nerves, skin) is damaged in a zone that extends far beyond the fracture line. This explains:
- Why open fracture wounds are debrided widely
- Why compartment syndrome develops even in closed fractures
- Why high-energy fractures have higher complication rates than low-energy fractures even with similar bony patterns
From Part 2 and senior notes [2][3]:
| Grade | Wound Size | Description | Antibiotic Protocol |
|---|---|---|---|
| I | < 1 cm | Low energy, minimal contamination & soft tissue injury | 1st gen cephalosporin |
| II | 1–10 cm | Moderate energy, moderate contamination & soft tissue injury | 1st gen cephalosporin |
| IIIA | Usually > 10 cm | High energy, adequate soft tissue covers wound | 1st gen cephalosporin + aminoglycoside |
| IIIB | Usually > 10 cm | Extensive periosteal stripping requiring soft tissue transfer (flap) | 1st gen cephalosporin + aminoglycoside |
| IIIC | Usually > 10 cm | Vascular injury requiring vascular repair | 1st gen cephalosporin + aminoglycoside |
This links to the lecture's mention of "Major Crush Injury" as a life-threatening orthopaedic injury [1][6]:
- During extrication: Start IV fluid resuscitation (aggressive NS) before releasing the compression — this dilutes the potassium and myoglobin that will be released upon reperfusion
- Signs of limb-threatening injury after extrication: swelling, pain on passive stretch, paraesthesia, pulselessness, paralysis (the 5 P's of compartment syndrome)
- Urine test finding: Myoglobinuria (dipstick positive for blood but no RBCs on microscopy)
- Cause of cardiac arrest post-extrication: Hyperkalaemia (treat with IV calcium gluconate/chloride)
- Prevention of AKI: Aggressive IV fluid pre-extrication + urinary alkalinisation (sodium bicarbonate)
From Ryan Ho Critical Care notes, directly relevant to the haemorrhagic shock seen in pelvic fractures:
- Large bore IV access (14/16G at antecubital fossa)
- Blood for CBC, RFT, clotting, T&S
- Rapid crystalloid bolus (500–1000 mL) → reassess
- Type-specific or O-negative blood if not responding
- Foley catheter for urine output monitoring (aim > 0.5 mL/kg/h)
- Treat underlying cause — in pelvic fractures, this means external fixation [5]
Exam Intelligence
| Trap | Correct Thinking |
|---|---|
| Sending unstable patient for CT | Never send a haemodynamically unstable patient to CT. Stabilise first (ex-fix for pelvis), then image |
| Choosing embolisation as first step for unstable pelvic fracture | Embolisation is a secondary measure. External fixation comes first |
| Confusing life-threatening vs limb-threatening injuries | Haemorrhage = life-threatening; Compartment syndrome = limb-threatening |
| Forgetting cervical spine control during airway management | Always pair A with C-spine protection |
| Thinking open exploration is appropriate for pelvic bleeding | Opening the retroperitoneum releases the tamponade and worsens bleeding |
| Ordering daily X-rays for a simple fracture | Wasteful and not standard practice (this is a distractor in MCQs) |
| Confusing pelvic binder placement level | At greater trochanters, not iliac crests |
- External fixation vs embolisation: Ex-fix is first-line for unstable pelvic fracture; embolisation is second-line for persistent arterial bleeding
- Pelvic binder vs external fixation: Binder is temporary (pre-hospital/A&E); ex-fix is definitive initial stabilisation
- Damage control vs early total care: DCO for unstable polytrauma patients; early total care for stable patients with isolated injuries
Past Paper Questions
"A 40-year-old motorcyclist sustained injury to his pelvis in a road traffic accident. Despite resuscitation in the emergency room, the blood pressure remained unstable at 80/42 mmHg. Anteroposterior X-ray of the pelvis taken at the emergency room showed pelvic fracture. Which of the following is the MOST APPROPRIATE next step?"
A. Arterial embolisation B. External fixation ✓ C. Open exploration and ligation of bleeding vessel D. Urgent computed tomography scan of the pelvis
Answer: B. External fixation
Rationale: This is essentially the same question that appears on the lecture slides [1]. The patient is haemodynamically unstable — you cannot send them for CT (D). External fixation reduces pelvic volume (up to 35%), achieves tamponade, and reduces micromotion/shearing. Embolisation (A) is a secondary measure if ex-fix fails. Open exploration (C) is contraindicated as it releases the tamponade effect.
"A 56-year-old lady suffered from left distal radius fracture after a slip and fall injury on level ground. She was treated with closed reduction and a Plaster of Paris cast was applied for her to immobilise the fracture. The next day, she reported severe pain in her left wrist, with numbness in her fingertip and difficulty extending her fingers due to shooting pain and swelling. What is the MOST APPROPRIATE next step of management?"
A. Emergency carpal tunnel release B. Emergency fasciotomy C. Opioid analgesics D. Removing the Plaster of Paris cast ✓
Answer: D. Removing the Plaster of Paris cast
Rationale: This is a presentation of suspected compartment syndrome under a cast. The first step before any surgical intervention is to remove the constricting cast/dressing. This alone can reduce compartment pressure by 40–60%. If symptoms persist after cast removal, then proceed to fasciotomy. Opioids (C) mask the cardinal symptom of compartment syndrome (pain out of proportion) and are dangerous. This links to the lecture's learning objective on compartment syndrome management [1].
"A 28-year-old man is trapped under rubble from waist down after an earthquake. He has been trapped for around six hours. He is alert and only complains of pain in the lower limbs."
(a) Apart from pain control, what treatment will you start during extrication? (1 mark) (b) Name four important signs of a limb-threatening injury (4 marks) (c) Urine test finding suggesting crush syndrome? (1 mark) (d) Cause of cardiac arrest 5 minutes after extrication? Drug to treat? (2 marks) (e) Prevention of acute renal failure in the prehospital phase? (2 marks)
Markscheme answers:
- (a) IV fluid resuscitation (aggressive normal saline — start BEFORE extrication to prevent reperfusion syndrome)
- (b) Swelling, pain on passive stretch, paraesthesia/numbness, absent/weak pulses, paralysis (5 P's — any 4)
- (c) Myoglobinuria (urine dipstick positive for "blood" but no RBCs on microscopy)
- (d) Hyperkalaemia → IV calcium gluconate (or calcium chloride) — stabilises myocardium
- (e) Aggressive IV fluids + urinary alkalinisation (IV sodium bicarbonate) to prevent myoglobin precipitation in renal tubules
"A 40-year-old man sustained a whiplash injury in a car crash. Which of the following findings suggests a high risk of respiratory compromise?"
A. Bilateral hand numbness and clumsiness B. Loss of cervical lordosis C. Raised diaphragm on chest radiograph ✓ D. Systemic hypotension and bradycardia
Answer: C. Raised diaphragm on chest radiograph
Rationale: A raised hemidiaphragm indicates phrenic nerve palsy (C3-C5). If bilateral (as in high cervical cord injury), the patient cannot breathe independently. This is relevant to the lecture's emphasis on cervical spine protection and the ATLS A/B assessment [1]. Option D (hypotension + bradycardia) suggests neurogenic shock (loss of sympathetic tone) but is not specifically about respiratory compromise.
"Your trauma team is taking care of a middle-aged man who is a victim of a traffic collision. Multiple rib fractures are clinically suspected during primary survey... How would you control his pain during resuscitation for trauma in the A&E?"
A. Inhalational nitrous oxide and oxygen mixture (Entonox®) B. Intercostal nerve block with lignocaine C. Intravenous morphine ✓ D. Rectal diclofenac sodium
Answer: C. Intravenous morphine
Rationale: During active resuscitation, IV opioids are the standard for pain control because they are rapidly titratable. Entonox requires patient cooperation and a functioning respiratory system. Intercostal nerve block is appropriate later but not during primary survey. Rectal NSAIDs are inappropriate in acute trauma (bleeding risk, unpredictable absorption).
"Increased cardiac output, decreased blood pressure and decreased systemic vascular resistance are characteristically seen in which type of shock?"
A. Cardiogenic B. Distributive ✓ C. Hypovolaemic D. Obstructive
Answer: B. Distributive
Rationale: Distributive shock (septic, neurogenic, anaphylactic) features vasodilation (↓SVR), which triggers compensatory ↑CO, but BP still falls because the vasodilation is so profound. Hypovolaemic shock (as seen in pelvic fracture haemorrhage) would show ↓CO, ↑SVR (compensatory vasoconstriction), ↓BP. Understanding shock types is essential for the polytrauma assessment in this lecture [1][5].
| Fact | Number | Source |
|---|---|---|
| Pelvic volume reduction with ex-fix | Up to 35% | Lecture slide [1] |
| Blood loss from femoral shaft fracture | 1–1.5 L per femur | Standard teaching |
| Warm ischaemia time for irreversible muscle necrosis | 6 hours | Standard teaching |
| Trauma series films | 3 (CXR, Pelvis, C-spine) | Lecture slide [1] |
| GCS for severe head injury | 3–8 | ATLS [1] |
| Trimodal death peaks | Minutes, Hours, Days | Lecture slide [1] |
High Yield Summary
Save Life → Save Limb → Save Function — this hierarchy governs every decision in polytrauma.
Trimodal death: minutes (airway/head/chest), hours (haemorrhage), days (MODS/sepsis). We intervene at the second peak.
ATLS: A-B-C-D-E with cervical spine control. Trauma series = CXR + Pelvis XR + C-spine lateral.
Fracture priority: Open fractures > Pelvic > Spinal > Femoral > Other long bones.
Pelvic fracture haemorrhage: Binder (temporary) → External fixation (mandatory, reduces volume 35%, tamponade effect, reduces shearing) → Embolisation/Packing (secondary). Never send an unstable patient for CT. External fixation is the answer for unstable pelvic fracture with ongoing haemorrhage.
Early fracture stabilisation reduces ARDS by preventing fat embolism and ongoing inflammatory stimulus.
Damage Control Orthopaedics: Temporary stabilisation → ICU resuscitation → Staged definitive fixation over days.
Life-threatening orthopaedic injuries: Haemorrhage, major crush, proximal amputation, multiple fractures.
Limb-threatening injuries: Vascular injury, compartment syndrome, major joint dislocation, open fractures.
Active Recall - High Energy Trauma & Open Fracture Part 1
[1] Lecture slides: GC 231. High Energy Trauma Open Fracture_Part 1.pdf (all slides p1–p25) [2] Lecture slides: GC 231. High Energy Trauma Open Fracture_Part 2.pdf (p14 — soft tissue injury concept) [3] Senior notes: Maksim Surgery Notes.pdf (p214 — open fracture management, Gustilo-Anderson classification) [4] Senior notes: Ryan Ho Radiology.pdf (p1 — trauma imaging, trauma series) [5] Senior notes: Ryan Ho Critical Care.pdf (p21 — management of hypovolaemic shock) [6] Past papers: 2017 Fourth Summative SAQ.pdf (Q9 — crush injury) [7] Past papers: 2020 Fourth Summative Assessment MCQ paper.pdf (Q72 — shock types) [8] Past papers: 2022 Fourth Summative MCQ.pdf (Q62 — whiplash/respiratory compromise; Q78 — pain control in trauma) [9] Past papers: 2025 Fourth Summative MCQ.pdf (Q45 — pelvic fracture management; Q46 — compartment syndrome under cast)
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