Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma.

(SBQ12TR.18) A 21-year-old male is brought to the emergency department with multiple gun shot wounds. Initial radiographic evaluation discovers a femoral shaft fracture, distal tibia fracture, and the injury shown in Figure A. Figure B shows a single entry wound located at the left distal humerus. Systemic injuries include multiple abdominal bullet wounds with associated intra-abdominal free fluid. Using the 'damage-control' approach to orthopaedic trauma, what would be the best initial management for the injury seen in Figure A?

(OBQ12.18) A 36-year-old man sustains blunt chest trauma, an open right femur fracture, and a closed left tibia fracture following a high-speed MVC. Upon presentation to the emergency room, blood pressure is 80/40, HR 135, and urine output is .4 cc/kg/hr. Fluids and blood products are administered, and the patient is transferred to the ICU for further care. As an alternative to lactate and base deficit measurements, which of the following would best indicate adequate resuscitation has been achieved?

(OBQ09.237) A 34-year-old man is brought to the trauma bay following a motorcycle collision with a left femoral shaft fracture and an open right tibial plateau fracture. Radiographs are provided in figures A and B. He is proceeding to the operating room for an emergent splenectomy. The mean arterial pressure is 51 mmHg following 6 units of packed red blood cells as well as crystalloid replacement. Base deficit is 10 mmol/L. Neurosurgery is concerned for evolving subdural hematoma and is recommending serial head CT scans. Which of the following is the best immediate treatment option to address his fractures?

(OBQ07.198) Residual end-organ hypoperfusion in a polytraumatized patient is shown by which of the following?