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Open tibial fracture — MCCQE Part 1 MCQ

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HardTraumaOpen tibial fractureMCCQE Part 1

A 34-year-old construction worker presents after a crush injury with an open mid-shaft tibial fracture contaminated with soil. Distal pulses and sensation are intact. He is unsure of his tetanus status. What is the most appropriate next step in management?

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Correct answer: B — Give intravenous antibiotics, tetanus prophylaxis, sterile dressing and urgent orthopaedic referral

Open fractures require early IV antibiotics, tetanus assessment, sterile coverage, immobilisation and urgent orthopaedic management. Primary closure in the emergency department is inappropriate for a contaminated open fracture. Cultures should not delay antibiotic treatment.

Reference: Canadian Orthopaedic Association resources; NACI tetanus guidance