Pelvic Fractures, Polytrauma, Damage Control Orthopaedics, and Fat Embolism Syndrome — WACS Viva & Clinical Scenarios (Orthopaedics & Trauma)

Exam-style pelvic fractures, polytrauma, damage control orthopaedics, and fat embolism syndrome viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 32-year-old male (ASA 4E) sustains an unstable vertical shear pelvic fracture and closed head injury in an inter-city bus crash. He is tachycardic (HR 144 bpm), hypotensive (BP 70/40 mmHg) despite 2 L crystalloid, and has an unstable pelvic binder in situ. He is scheduled for emergent pelvic external fixation and laparotomy. How do you manage his resuscitation and anaesthetic induction?
• SCENARIO 2: A 24-year-old male (ASA 1E) with bilateral closed femoral shaft fractures awaiting surgery develops sudden onset tachypnoea (RR 38/min), SpO2 82% on room air, petechiae over the axillae and conjunctivae, and acute delirium 36 hours post-injury. Outline your immediate diagnostic confirmation, critical care stabilisation, and anaesthetic strategy.
• SCENARIO 3: A 45-year-old female (ASA 3E) is brought in 18 hours after a high-speed collision with open bilateral open tibia fractures and an unstable pelvic crush injury. Serum potassium is 6.2 mmol/L, base deficit is -12 mmol/L, and core temperature is 34.8°C. The orthopaedic team wants to perform immediate 6-hour bilateral plating and reamed intramedullary nailing. How do you defend Damage Control Orthopaedics over Early Total Care?
• SCENARIO 4: A 28-year-old construction worker (ASA 3E) with a severe crush injury to both lower extremities for 8 hours presents for emergent debridement and external fixation. Urine is dark reddish-brown with dipstick positive for blood but no microscopy RBCs. How do you assess, prepare, and anaesthetise this patient while preventing lethal dysrhythmias and acute renal shutdown?