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Open tibial fracture — DipIMC MCQ

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HardTraumaOpen tibial fractureDipIMC

A 29-year-old climber has an open tibial fracture with a pale cool foot after a fall. Bleeding is controlled and extrication to the road is possible within 10 minutes. What is the most appropriate immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: ARealign the limb gently and reassess distal perfusion

Explanation lettering: E = shown as B · D = shown as C · B = shown as D · C = shown as E

A is correct: Gross deformity with threatened distal perfusion may require gentle realignment and splinting to restore circulation. B is less suitable because it does not address the discriminator in the vignette; C is less suitable because it delays the immediate life-saving step in the cABCDE sequence; D is less suitable because it creates avoidable delay in a time-critical presentation; E is less suitable because it moves the patient before the decisive threat or destination issue is addressed. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; NICE Major Trauma NG39; ATACC