PHTLS Musculoskeletal Trauma 3 — Questions and Answers
Question 1: A patient sustains a crush injury to the lower leg after being pinned under a vehicle for 45 minutes. After extrication, which systemic complication is of greatest concern?
- Fat embolism syndrome
- Rhabdomyolysis leading to acute renal failure (Correct answer)
- Deep vein thrombosis
- Septic arthritis
Correct answer: Rhabdomyolysis leading to acute renal failure
Prolonged crush injury releases myoglobin from damaged muscle into the bloodstream, which can precipitate in renal tubules and cause acute renal failure.
Question 2: Which anatomical landmark is used to position a pelvic binder correctly to stabilize an open-book pelvic fracture?
- Iliac crests
- Greater trochanters (Correct answer)
- Pubic symphysis
- Anterior superior iliac spines
Correct answer: Greater trochanters
The pelvic binder must be centered over the greater trochanters, not the iliac crests, to effectively close the pelvic ring.
Question 3: A 22-year-old athlete has a suspected anterior shoulder dislocation after a fall. Distal neurovascular function is intact. What is the PHTLS-recommended prehospital approach?
- Attempt closed reduction using the Stimson technique
- Immobilize the arm in the position of comfort with a sling and swathe (Correct answer)
- Apply longitudinal traction to reduce the dislocation before transport
- Apply ice and avoid immobilization to allow muscle relaxation
Correct answer: Immobilize the arm in the position of comfort with a sling and swathe
PHTLS does not advocate field reduction of dislocations; the joint should be immobilized in the position of comfort with a sling and swathe and the patient transported.
Question 4: Which of the following fractures is considered MOST immediately life-threatening due to its hemorrhage potential?
- Bilateral tibia fractures
- Open radius fracture
- Unstable pelvis fracture (Correct answer)
- Humeral shaft fracture
Correct answer: Unstable pelvis fracture
An unstable pelvis fracture can result in massive retroperitoneal hemorrhage with blood loss exceeding 3–4 liters, making it the most immediately life-threatening fracture.
Question 5: A patient is found with a deformed, shortened, and externally rotated lower extremity after a fall from a ladder. What injury does this presentation MOST suggest?
- Tibial plateau fracture
- Anterior hip dislocation
- Hip fracture (femoral neck or intertrochanteric) (Correct answer)
- Femoral shaft fracture
Correct answer: Hip fracture (femoral neck or intertrochanteric)
A shortened, externally rotated lower extremity after trauma in an elderly patient is classic for a proximal femur (hip) fracture.
Question 6: When splinting a suspected wrist fracture, the splint should immobilize which joints?
- Wrist joint only
- Wrist and elbow joints (Correct answer)
- Wrist joint and metacarpophalangeal joints
- Elbow, wrist, and finger joints
Correct answer: Wrist and elbow joints
A wrist fracture splint should immobilize the joint above (elbow) and the joint below (wrist/hand) to prevent motion at the fracture site.
Question 7: A 35-year-old patient has a suspected posterior knee dislocation with a cold, pulseless foot. Transport time is 40 minutes. What is the BEST course of action?
- Splint in position found and transport immediately
- Attempt gentle realignment to restore blood flow, reassess pulse, then transport (Correct answer)
- Apply arterial tourniquet above the knee and transport
- Elevate and apply a warm pack to the foot while transporting
Correct answer: Attempt gentle realignment to restore blood flow, reassess pulse, then transport
Knee dislocations with vascular compromise warrant one careful attempt at reduction to restore perfusion, followed by reassessment and rapid transport.
PHTLS Musculoskeletal Trauma 3
A patient sustains a crush injury to the lower leg after being pinned under a vehicle for 45 minutes.
After extrication, which systemic complication is of greatest concern?