PHTLS Musculoskeletal Trauma 5 — Questions and Answers
Question 1: A pediatric patient sustains a fracture through the growth plate of the distal tibia. Which fracture classification system specifically addresses physeal (growth plate) injuries?
- AO/OTA Classification
- Gustilo-Anderson Classification
- Salter-Harris Classification (Correct answer)
- Denis Classification
Correct answer: Salter-Harris Classification
The Salter-Harris classification describes fractures involving the physis (growth plate) in pediatric patients, which are significant because they can affect bone growth.
Question 2: Which of the following is the MOST appropriate initial field treatment for a suspected scapular fracture?
- Apply a rigid figure-of-eight clavicle splint
- Immobilize with a sling and swathe and monitor for respiratory compromise (Correct answer)
- Apply a traction splint to the affected shoulder girdle
- Secure the arm above the head to decompress the glenohumeral joint
Correct answer: Immobilize with a sling and swathe and monitor for respiratory compromise
Scapular fractures indicate significant force and are associated with thoracic injuries; immobilize with a sling and swathe and monitor carefully for pneumothorax or pulmonary contusion.
Question 3: When using a vacuum splint for an ankle fracture-dislocation, what is the PRIMARY advantage over rigid splints in the prehospital environment?
- Provides greater traction along the long axis of the limb
- Conforms to irregular deformities and reduces pressure points (Correct answer)
- Generates more rigid immobilization than plaster casting
- Allows direct visualization of the fracture site during transport
Correct answer: Conforms to irregular deformities and reduces pressure points
Vacuum splints conform to the shape of the deformed extremity, providing comfortable immobilization while distributing pressure evenly and reducing pressure point injury.
Question 4: A patient involved in a high-energy MVC has a suspected calcaneus (heel bone) fracture. What associated injury should be specifically evaluated based on the mechanism?
- Contralateral hip fracture
- Lumbar vertebral compression fractures (Correct answer)
- Metatarsal stress fractures
- Tibial plateau fracture
Correct answer: Lumbar vertebral compression fractures
Calcaneus fractures from axial loading (falls or foot-well intrusion) are associated with lumbar spine compression fractures due to transmission of forces up the extremity.
Question 5: Which of the following BEST describes the PHTLS principle for managing an extremity fracture in a critical trauma patient with airway compromise and suspected internal hemorrhage?
- Fully splint all fractures before addressing the airway
- Rapidly splint fractures only if time permits after life threats are controlled (Correct answer)
- Delay all fracture management until arrival at the trauma center
- Apply traction splints en route while the partner manages the airway
Correct answer: Rapidly splint fractures only if time permits after life threats are controlled
PHTLS follows the principle that life threats (airway, breathing, circulation) are addressed before limb threats; fracture splinting is performed only after life-threatening problems are controlled or concurrently en route when feasible.
Question 6: Which neurovascular check finding after splint application should prompt immediate splint removal and reassessment?
- Mild increase in swelling distal to the splint
- New onset of numbness or tingling distal to the splint (Correct answer)
- Capillary refill of 2 seconds at the fingertips
- Mild pain at the fracture site when palpated
Correct answer: New onset of numbness or tingling distal to the splint
New onset numbness or tingling after splint application suggests nerve compression from the splint and requires immediate loosening or removal and reassessment.
Question 7: A 70-year-old female with osteoporosis trips and falls, landing on an outstretched hand. Which fracture is MOST likely given this mechanism and patient population?
- Scaphoid fracture
- Distal radius fracture (Colles' fracture) (Correct answer)
- Metacarpal neck fracture
- Olecranon fracture
Correct answer: Distal radius fracture (Colles' fracture)
A distal radius fracture (Colles' fracture) is the most common fracture in elderly osteoporotic women who fall on an outstretched hand (FOOSH mechanism).
PHTLS Musculoskeletal Trauma 5
A pediatric patient sustains a fracture through the growth plate of the distal tibia.
Which fracture classification system specifically addresses physeal (growth plate) injuries?