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Open fracture — DIPIMC MCQ

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ModeratePre-Hospital TraumaOpen fractureDIPIMCDipIMC

A 30-year-old has an open fracture of the tibia after a fall from height, with bone visible through a 4 cm wound and minimal external bleeding. Distal pulses are present and the limb is grossly deformed. After analgesia, what is the most appropriate pre-hospital management of the wound and limb?

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Correct answer: A — Cover the wound, realign and splint the limb, and recheck the neurovascular status

An open long-bone fracture is managed by removing gross contamination, covering the wound with a saline-soaked dressing, gently realigning and splinting the limb, and documenting neurovascular status before and after. Vigorous scrubbing causes further tissue damage, and a tourniquet is unnecessary when bleeding is minimal and distal perfusion intact. Photographing the wound and giving early antibiotics are also recommended. Pearl: realignment that restores distal perfusion takes priority over a perfect anatomical reduction.

Reference: NICE NG39 (Major Trauma); JRCALC Clinical Guidelines