PHTLS Musculoskeletal Trauma 2 — Questions and Answers
Question 1: A patient has a suspected femur fracture with a thigh that appears significantly swollen and tense. What is the primary concern regarding blood loss?
- Up to 500 mL can be lost into the thigh
- Up to 1,000 mL can be lost into the thigh
- Up to 1,500 mL can be lost into the thigh
- Up to 2,000 mL or more can be lost into the thigh (Correct answer)
Correct answer: Up to 2,000 mL or more can be lost into the thigh
A closed femur fracture can result in 1,000–2,000 mL or more of blood loss into the thigh compartment.
Question 2: When applying a traction splint to a mid-shaft femur fracture, which of the following is a contraindication?
- Open femur fracture with minimal contamination
- Suspected hip fracture or dislocation (Correct answer)
- Bilateral femur fractures
- Patient in hemorrhagic shock
Correct answer: Suspected hip fracture or dislocation
Traction splints are contraindicated when there is a suspected hip fracture or dislocation, as traction could worsen the injury.
Question 3: A construction worker falls and presents with an angulated lower leg deformity, absent distal pulse, and pale foot. What is the MOST appropriate immediate action?
- Splint in position of deformity and transport rapidly
- Attempt one gentle realignment to restore circulation, then splint (Correct answer)
- Apply traction to fully reduce the fracture before splinting
- Elevate the limb and apply ice before splinting
Correct answer: Attempt one gentle realignment to restore circulation, then splint
When a neurovascular deficit is present, one attempt at gentle longitudinal realignment is indicated to try to restore circulation prior to splinting.
Question 4: Which assessment finding best indicates compartment syndrome developing in a forearm after a radius fracture?
- Skin discoloration over the fracture site
- Pain with passive stretch of the fingers that is out of proportion to the injury (Correct answer)
- Swelling limited to the fracture site
- Decreased capillary refill in the ipsilateral hand only
Correct answer: Pain with passive stretch of the fingers that is out of proportion to the injury
Pain with passive stretch of the muscles in the affected compartment that is disproportionate to the injury is the hallmark early sign of compartment syndrome.
Question 5: A patient with a pelvic fracture from a high-speed MVC is hypotensive and tachycardic. Which prehospital intervention is MOST appropriate to reduce ongoing hemorrhage?
- Pneumatic antishock garment (PASG) inflation
- Application of a pelvic binder at the level of the greater trochanters (Correct answer)
- Bilateral femoral traction splints
- Pelvic compression using a long backboard and straps
Correct answer: Application of a pelvic binder at the level of the greater trochanters
A pelvic binder applied at the level of the greater trochanters closes the pelvic ring and reduces hemorrhage from unstable pelvic fractures.
Question 6: Which type of fracture pattern is MOST commonly associated with high-velocity gunshot wounds to long bones?
- Transverse fracture
- Oblique fracture
- Comminuted fracture (Correct answer)
- Greenstick fracture
Correct answer: Comminuted fracture
High-velocity projectiles transfer massive energy, fragmenting bone into multiple pieces and creating a comminuted fracture pattern.
Question 7: During scene assessment of a motorcycle crash patient, you notice a wound over the lateral knee with visible bone. The patient reports knee pain and cannot bear weight. How should this wound be managed before splinting?
- Irrigate vigorously with normal saline to clean the wound
- Cover with a moist sterile dressing, then splint to include joints above and below (Correct answer)
- Pack the wound tightly with dry gauze and secure with a pressure bandage
- Leave uncovered to prevent moisture buildup under the splint
Correct answer: Cover with a moist sterile dressing, then splint to include joints above and below
Open fracture wounds should be covered with a moist sterile dressing to protect exposed bone while the extremity is splinted including the joints above and below the injury.
PHTLS Musculoskeletal Trauma 2
A patient has a suspected femur fracture with a thigh that appears significantly swollen and tense.
What is the primary concern regarding blood loss?