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Open fracture — MCCQE Part 1 MCQ

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EasyFracturesOpen fractureMCCQE Part 1

36-year-old construction worker presents with forearm deformity after a fall. There is a wound communicating with bone. Which of the following is the most appropriate next step?

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Correct answer: B — Cover with sterile dressing, give IV antibiotics and tetanus prophylaxis, and urgently involve orthopaedics

Cover with sterile dressing, give IV antibiotics and tetanus prophylaxis, and urgently involve orthopaedics is best because open fracture risks infection and needs urgent antibiotic and surgical management. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Antibiotics are time-critical in open fractures.

Reference: Canadian Orthopaedic Association guidance