TEOT Ortopedia Practice Questions - TEOT - Título De Especialista Em Ortopedia E Traumatologia (Sociedade Brasileira De Ortopedia E Traumatologia AMB) Exam

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A 24-year-old male polytrauma patient is brought to the trauma center following a high-speed collision. He presents with severe bilateral pulmonary contusions, an open Gustilo IIIA femoral shaft fracture, and a closed pelvic ring injury. In the operating room, his core temperature is 34.2°C, arterial blood gas shows pH 7.20 and base deficit -8.5 mEq/L, and platelet count is 65,000/uL with active microvascular oozing. In accordance with Damage Control Orthopedics (DCO) principles, what is the most appropriate initial skeletal management?

Definitive reamed antegrade intramedullary nailing of the femur and open reduction and internal plating of the pelvic ring. Rapid application of a temporary spanning external fixator to the femur and pelvic binder/external fixation, followed by transfer to the ICU for physiological resuscitation. Immediate skeletal traction with a distal femoral traction pin and delayed surgery after 72 hours in the general ward. Primary unreamed femoral intramedullary nailing under local hematoma block and intravenous sedation.

Correct Answer:

Rapid application of a temporary spanning external fixator to the femur and pelvic binder/external fixation, followed by transfer to the ICU for physiological resuscitation.

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