Complications: Compartment Syndrome, Crush Syndrome, Fat Embolism, Neurovascular Compromise, Infection, and DVT Practice Questions

25 multiple-choice questions on Complications: compartment syndrome, crush syndrome, fat embolism, neurovascular compromise, infection, and DVT for paramedic and EMT students, from Chapter 38 (Orthopaedic Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. An intubated, sedated patient has a crushed forearm. Because he cannot report pain, the best way to watch for compartment syndrome is to:

   1. A. Watch for loss of the radial pulse
   2. B. Feel for a tense, firm compartment
   3. C. Check capillary refill in the fingers
   4. D. Test the sensation in his fingers
   Show answer

   Answer: B. Feel for a tense, firm compartment

   Pain is the earliest sign of compartment syndrome, so in unconscious or sedated patients it is easily missed. Serially palpate the compartments for increasing tension, watch for swelling, and report the concern so pressures can be measured. Loss of the pulse and slow capillary refill are late findings, often absent until severe damage has occurred, and sensation cannot be tested reliably in a sedated patient.

2. A 5-year-old has a fever and refuses to bear weight on one leg. The hip is held flexed and is painful to move, but there was no injury. You should suspect:

   1. A. A slipped capital epiphysis
   2. B. Perthes disease
   3. C. A toddler's fracture of the tibia
   4. D. Septic arthritis of hip
   Show answer

   Answer: D. Septic arthritis of hip

   Fever with refusal to bear weight and a painful, flexed hip in a child suggests a joint infection, which can destroy the joint within hours to days and needs urgent evaluation. Slipped capital femoral epiphysis affects older, often overweight adolescents, Perthes disease causes a gradual limp without fever, and a toddler's fracture follows a twist or fall and involves the lower leg rather than a painful, flexed hip.

3. A woman with a displaced wrist fracture has worsening numbness and tingling in the thumb, index, and middle fingers. This suggests compression of the:

   1. A. Median nerve
   2. B. Ulnar nerve
   3. C. Radial artery
   4. D. Axillary nerve
   Show answer

   Answer: A. Median nerve

   Swelling or a displaced distal radius fracture can compress the median nerve in the carpal tunnel, causing numbness of the thumb, index, middle, and part of the ring finger. Progressive symptoms need urgent evaluation. The ulnar nerve supplies the little finger side, and the axillary nerve is at the shoulder.

4. A 6-year-old with an isolated closed femur fracture is hypotensive and tachycardic. You should:

   1. A. Blame the femur fracture alone for it
   2. B. Apply ice and wait for the pressure
   3. C. Search for another source of bleeding
   4. D. Give a sedative to slow the heart
   Show answer

   Answer: C. Search for another source of bleeding

   An isolated femur fracture in a child can cause significant blood loss but rarely explains hypotension by itself, so shock should prompt a search for intra-abdominal, chest, or pelvic bleeding. Treat for shock and transport to a pediatric-capable trauma center.

5. A woman's shoulder dislocated during a fall but popped back in before you arrived. She now has little pain. You should:

   1. A. Release her because it is back in place
   2. B. Splint it and transport for evaluation
   3. C. Apply ice and advise a clinic visit
   4. D. Check range of motion, then release
   Show answer

   Answer: B. Splint it and transport for evaluation

   A spontaneously reduced dislocation may have associated fractures or nerve and vessel injury, and the joint is unstable. Check distal pulses, motor function, and sensation, immobilize it with a sling, and transport for imaging. Ice and a later clinic visit delays imaging for a fracture or nerve injury, and testing the range of motion can cause the joint to dislocate again.

6. Minutes after a man pinned for 6 hours is freed, his ECG changes from peaked T waves to a very wide QRS that merges with the T wave in a sine-wave pattern. This indicates:

   1. A. The potassium level is now falling
   2. B. This is a harmless reperfusion artifact
   3. C. Atropine-responsive heart block
   4. D. Hyperkalemic arrest is imminent
   Show answer

   Answer: D. Hyperkalemic arrest is imminent

   Hyperkalemia progresses on the ECG from peaked T waves to a lengthening PR interval, loss of P waves, and a widening QRS that finally blends with the T wave into a sine wave, the last rhythm before ventricular fibrillation or asystole. Give IV calcium at once (calcium chloride 1 g or calcium gluconate about 3 g, repeated if the ECG does not improve), then sodium bicarbonate, nebulized albuterol, and fluids per protocol, and prepare for arrest. A widening QRS means the potassium is rising, not falling. Reperfusion of crushed muscle is what releases the potassium, so the change is real, not an artifact. The wide, slow complexes come from potassium slowing conduction in the heart muscle, so atropine does not help. (Calcium chloride irritates veins and needs a secure large-bore line.)

7. Fat embolism syndrome most commonly develops:

   1. A. Within minutes of the injury
   2. B. About 2 weeks after surgery
   3. C. 24 to 72 hours after injury
   4. D. After the bone has healed
   Show answer

   Answer: C. 24 to 72 hours after injury

   Fat globules released from long-bone marrow travel to the lungs, brain, and skin, and symptoms usually appear 1 to 3 days after the fracture. This delay is why paramedics may meet it during interfacility transfers or after discharge.

8. A 22-year-old who fractured his femur 2 days ago has new confusion, dyspnea, SpO2 86%, and tiny red spots on his chest and axillae. You suspect:

   1. A. Compartment syndrome
   2. B. Septic shock from a UTI
   3. C. Hemorrhagic shock
   4. D. Fat embolism syndrome
   Show answer

   Answer: D. Fat embolism syndrome

   The triad of respiratory distress, altered mental status, and a petechial rash after a long-bone fracture is classic for fat embolism. Septic shock usually brings fever and hypotension without the petechial rash in this distribution.

9. A patient with multiple injuries was stabilized and his obvious fractures splinted. Small hand and foot fractures in such patients are often:

   1. A. Missed on the first assessment
   2. B. Identified during the primary survey
   3. C. Too minor to need splinting later
   4. D. Found on the rapid trauma scan
   Show answer

   Answer: A. Missed on the first assessment

   Attention goes to life threats and large deformities, so small bone, hand, and foot injuries are commonly missed in multiple-trauma patients, especially if they are unconscious. Repeat the secondary assessment when time allows and report all tender, swollen, or deformed areas. The primary survey and rapid scan do not look for them, and they still need splinting because they can cause long-term disability.

10. Field management of suspected fat embolism syndrome focuses mainly on:

    1. A. Anticoagulation with heparin
    2. B. Oxygenation and ventilation
    3. C. Rapid traction removal
    4. D. High-dose antibiotics
    Show answer

    Answer: B. Oxygenation and ventilation

    There is no specific antidote, so treatment is supportive: high-flow oxygen, ventilatory support, and monitoring. Heparin is not a field treatment and is not proven to help fat embolism.

11. Early immobilization of long-bone fractures helps prevent fat embolism because it:

    1. A. Lowers the heart rate
    2. B. Dissolves the fat globules
    3. C. Thins the patient's blood
    4. D. Limits marrow fat release
    Show answer

    Answer: D. Limits marrow fat release

    Movement of unstable bone ends can force more fat from the marrow into torn veins, so good splinting reduces the risk. Splinting has no effect on fat once it is in the circulation.

12. An ankle fracture-dislocation has a bone end pushing the skin outward, and that skin is turning white. The main danger to this skin is that it:

    1. A. Means the fracture is already open underneath
    2. B. Can die and turn this into an open fracture
    3. C. Signals a nerve injury below the ankle
    4. D. Shows the foot has lost its arterial supply
    Show answer

    Answer: B. Can die and turn this into an open fracture

    Skin tented tightly over a displaced bone loses blood flow and can break down, turning a closed fracture into an open one. Gentle realignment per protocol and splinting relieve the pressure. Blanched skin from tenting reflects local pressure, not an open fracture yet, a nerve injury, or loss of the arterial supply to the foot, although distal PMS should still be checked.

13. Several days after a tibia fracture, which finding most suggests a deep vein thrombosis?

    1. A. Bilateral pale, cool feet
    2. B. Petechiae on the chest wall
    3. C. One swollen, warm calf
    4. D. Tea-colored urine output
    Show answer

    Answer: C. One swollen, warm calf

    A DVT causes swelling, warmth, and aching of one leg from blocked venous return. Petechiae on the chest suggest fat embolism, the other delayed complication of long-bone fractures.

14. An open fracture is at highest risk for which complication in the days after injury?

    1. A. Osteomyelitis
    2. B. Fat necrosis
    3. C. Hyperkalemia
    4. D. Myositis ossificans
    Show answer

    Answer: A. Osteomyelitis

    Bacteria entering through the wound can infect bone, which is difficult to treat and can prevent healing. Hyperkalemia is a complication of crush syndrome, not of a simple open fracture.

15. Which open fracture carries the greatest risk of infection?

    1. A. A small puncture from a bone end
    2. B. A farm injury with soil in the wound
    3. C. A clean cut from broken window glass
    4. D. A wound covered within five minutes
    Show answer

    Answer: B. A farm injury with soil in the wound

    Gross contamination with soil or farm material brings the heaviest bacterial load, including clostridial and tetanus organisms, and is the highest-risk open fracture. A small inside-out puncture from a bone end is still an open fracture, but it is far less contaminated.

16. Some EMS systems give a first-generation cephalosporin such as cefazolin for open fractures with long transport times because:

    1. A. It prevents tetanus in the wound
    2. B. It sterilizes the wound right away
    3. C. It replaces the need for surgery
    4. D. Early antibiotics lower infection
    Show answer

    Answer: D. Early antibiotics lower infection

    Infection rates in open fractures rise the longer antibiotics are delayed, and trauma quality programs (ACS TQIP) set a target of within 60 minutes of arrival. The 2024 joint COT/OTA/ACEP/NAEMSP/NAEMT position statement supports EMS-given cefazolin (commonly 2 g IV) for suspected open fractures when it does not delay transport or treatment of life threats. Antibiotics do not replace surgical cleaning and debridement, do not sterilize a contaminated wound on contact, and do not prevent tetanus, which needs tetanus vaccine or immune globulin.

17. Before covering an open fracture, some trauma centers ask EMS to photograph the wound securely. The main purpose is to:

    1. A. Avoid reopening the dressing
    2. B. Post the images on social media
    3. C. Replace a written patient care report
    4. D. Let the patient refuse transport
    Show answer

    Answer: A. Avoid reopening the dressing

    Each time a dressing is removed to inspect an open fracture, contamination and bleeding increase. A secure photo per policy lets the trauma team see the wound without exposing it again. Images are protected health information and supplement, not replace, the report.

18. A fracture that heals in an abnormal, deformed position is called:

    1. A. Nonunion
    2. B. Delayed union
    3. C. Malunion
    4. D. Avulsion
    Show answer

    Answer: C. Malunion

    Malunion means the bone healed but in a poor position, causing deformity or loss of function. Nonunion means the fracture fails to heal at all.

19. Pressure from a displaced fracture fragment on an artery or nerve is most likely to cause:

    1. A. Fever and chills within hours
    2. B. Rising blood glucose levels
    3. C. Distal ischemia or numbness
    4. D. Petechiae on the chest
    Show answer

    Answer: C. Distal ischemia or numbness

    Bone fragments and swelling can compress or lacerate neurovascular structures, leading to a cool, pale limb or loss of sensation below the injury. Petechiae on the chest are a feature of fat embolism.

20. Which finding indicates the most urgent need to restore circulation in an injured extremity?

    1. A. Bruising around the ankle
    2. B. Swelling at the fracture site
    3. C. Pain when the toes move
    4. D. A cold, pale, pulseless foot
    Show answer

    Answer: D. A cold, pale, pulseless foot

    A pulseless, cold, pale limb means distal tissue is ischemic and can be lost within hours. Bruising and swelling are expected with most fractures.

21. An 80-year-old is found with a hip fracture after lying on a tile floor for 2 days. Her clothes are soaked with urine, and her temperature is 34.8°C (94.6°F). Along with splinting, you should:

    1. A. Remove wet clothing and warm her
    2. B. Apply ice packs over the hip
    3. C. Give cold IV fluids rapidly
    4. D. Wait to warm her at the hospital
    Show answer

    Answer: A. Remove wet clothing and warm her

    A long lie causes hypothermia as well as muscle breakdown, and cold worsens coagulopathy and bleeding from the fracture. Ice over the hip would add to heat loss in a patient who is already hypothermic.

22. Treatment of suspected rhabdomyolysis in a patient found after a long lie with a hip fracture includes:

    1. A. Fluid restriction to avoid edema
    2. B. IV fluids to protect the kidneys
    3. C. Diuretics before any IV fluid
    4. D. Oral potassium supplements
    Show answer

    Answer: B. IV fluids to protect the kidneys

    Generous isotonic fluids help flush myoglobin and prevent acute kidney injury. Restricting fluids allows myoglobin to precipitate in the renal tubules.

23. A 60-year-old with a closed femur fracture is restless, pale, and diaphoretic, with HR 124 and BP 92/60. The most likely complication is:

    1. A. Fat embolism syndrome
    2. B. Hemorrhagic shock
    3. C. Compartment syndrome
    4. D. Neurogenic shock
    Show answer

    Answer: B. Hemorrhagic shock

    A femur fracture can bleed heavily into the thigh, and tachycardia with pale, sweaty skin and narrowing BP signals hemorrhagic shock. Neurogenic shock causes warm, dry skin and relative bradycardia from loss of sympathetic tone.

24. Which long-term complication is most associated with fractures that enter a joint surface?

    1. A. Bone tumor formation
    2. B. Heterotopic skin calcification
    3. C. Post-traumatic arthritis
    4. D. Osteoporosis
    Show answer

    Answer: C. Post-traumatic arthritis

    An uneven joint surface after an intra-articular fracture wears the cartilage and leads to arthritis. Osteoporosis is a cause of fragility fractures, not a result of them.

25. Volkmann ischemic contracture is a late complication of:

    1. A. A healed scaphoid waist fracture
    2. B. A reduced anterior shoulder dislocation
    3. C. A sprain of the medial ankle
    4. D. Untreated forearm compartment syndrome
    Show answer

    Answer: D. Untreated forearm compartment syndrome

    Ischemia of the forearm flexor muscles, often after a pediatric supracondylar fracture, leads to fibrosis and a clawlike contracture of the hand and wrist. A reduced shoulder dislocation does not cause forearm muscle ischemia.