WBR287

Author	[[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
Exam Type	USMLE Step 2 CK
Main Category	Surgery
Sub Category	Musculoskeletal/Rheumatology, Musculoskeletal/Rheumatology
Prompt	A 24-year-old male gets involved in a school fight and is shot in the arm with a .38-caliber revolver. He is brought to the ER with the following vital signs: 88 bpm, T 37C, BP: 110/70mmHg, 22 respirations/min. Upon arrival to the hospital, the patient is exposed by the trauma team. The surgical resident on call observes an entrance wound in the medial aspect across the left extremity and an exit wound located on the lateral aspect of the left arm. He has a large hematoma in the medial aspect of the arm, radial pulse is non palpable. Fluid resuscitation is started and the radiologic bone survey reveals a shattered humerus fracture. Which of the following is the correct order in management?
Answer A	Vascular repair, followed by fracture stabilization, followed by nerve repair
Answer A Explanation	Incorrect.
Answer B	Nerve repair, followed by vascular repair, followed by fracture stabilization
Answer B Explanation	Incorrect.
Answer C	Fracture stabilization, followed by vascular repair, followed by nerve repair
Answer C Explanation	Correct. See overall explanation.
Answer D	Fracture stabilization, followed by nerve repair, followed by vascular repair
Answer D Explanation	Incorrect.
Answer E	Nerve repair, followed by fracture stabilization, followed by vascular repair
Answer E Explanation	Incorrect.
Right Answer	C
Explanation	[[Explanation::This patient is presenting with a gun shot wound involving the bone, nerve and artery, therefore he will need surgery. This question is asking what is the most appropriate order. Fist the bone should be stabilized (performing it last would damage the delicate and vascular and nerve repairs). After the fracture stabilization, the vessels (both artery and vein) are repaired. Lastly the nerve is repaired. Educational Objective: WikiDoc Mnemonic: The BANK: keeps the bones, artery and nerves in place. Bone--> Artery(vessel) --> Nerve References: Master the Boards for Step 2 CK, surgery chapter See also: Humerus fracture Educational Objective: References: ]]
Approved	No
Keyword	extremities trauma, humerus fracture, brachial artery, radial nerve palsy
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