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OR2.7-8 | Axial Skeleton Injuries — Assignment
CLINICAL SCENARIO
This assignment develops clinical reasoning for two of the most high-stakes axial skeleton injuries encountered in trauma: an unstable pelvic fracture with haemodynamic compromise, and an acute traumatic spinal cord injury requiring safe mobilisation. Students will construct an integrated management plan for a combined polytrauma case, applying knowledge of haemorrhage control, neurogenic physiology, and evidence-based rehabilitation principles.
Instructions
Read the clinical scenario carefully. Construct a structured written management plan covering all the sections listed in the scaffolding. Your response must demonstrate clinical depth appropriate to a final-year MBBS student. Use clear headings. Aim for 600–900 words.
Length: 600–900 words
What to Submit
1. Haemorrhage Control and Resuscitation
Guidance: Describe the immediate steps to control pelvic haemorrhage. Address: (a) What device do you apply, where, and why? (b) What is the blood product resuscitation strategy (rationale for balanced transfusion)? (c) If the patient remains haemodynamically unstable after initial measures, what is the next intervention and its rationale?
2. Management of the Urological Injury
Guidance: Explain the significance of blood at the urethral meatus and the correct sequence of investigation and bladder drainage. Name the investigation, the finding you expect, and the drainage method if urethral injury is confirmed.
3. Spinal Injury Assessment and Spinal Precautions
Guidance: Describe the clinical assessment of the spinal cord injury. Using the ASIA Impairment Scale, classify the injury. Describe the strict spinal precautions that must be maintained and explain WHY each is necessary in the context of an unstable Tile C pelvis and a concurrent spinal injury.
4. Imaging and Definitive Skeletal Management Plan
Guidance: Which imaging studies are required and in what order? Outline the definitive orthopaedic/surgical management plan for both the pelvic fracture (timing, approach, method) and the spine injury (classification, indications for surgery vs conservative).
5. Rehabilitation and Mobilisation Principles
Guidance: Describe the multidisciplinary rehabilitation plan for this patient once he is medically stable. Include: early vs delayed mobilisation rationale, precautions specific to spinal cord injury mobilisation (orthostatic hypotension, pressure sores, autonomic dysreflexia risk), and goals at 6 weeks.
Grading Rubric — Axial Skeleton Injuries Assignment Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Haemorrhage control and resuscitation | 10 pts | Correctly identifies pelvic binder at greater trochanters, applies balanced 1:1:1 transfusion rationale, correctly identifies angioembolisation as next step after failed binder; all steps logical and sequenced. |
| Urological injury management | 10 pts | Correctly identifies retrograde urethrogram before any catheter insertion; describes suprapubic catheterisation if urethral injury confirmed; explains why urethral catheterisation is contraindicated. |
| Spinal cord injury assessment and spinal precautions | 10 pts | Applies ASIA scale correctly; correctly identifies log-roll technique with four-person team, cervical collar maintained; explains that an unstable pelvis adds risk to standard log-roll and identifies scoop stretcher as preferred; rationale for each precaution is explicit. |
| Imaging and definitive skeletal management plan | 10 pts | Logical imaging sequence (X-ray → CT pelvis/spine → MRI cord); identifies both operative indications (Tile C pelvis = ORIF/external fix; unstable spine with neurological deficit = surgical decompression + instrumented stabilisation); timing of each discussed. |
| Rehabilitation and mobilisation principles | 10 pts | Identifies MDT team; describes tilt-table programme with orthostatic hypotension precautions (compression stockings, abdominal binder, gradual tilt); addresses autonomic dysreflexia recognition; pressure care; bladder programme; realistic 6-week goals stated. |
PEER REVIEW
Review your peer's management plan using the rubric criteria as your guide. For each section, provide: (1) one specific strength — a point where the reasoning is sound and clinically correct; (2) one constructive suggestion — a gap, inaccuracy, or area that could be expanded. Conclude with an overall comment on the integration of pelvic and spinal management. Your review should be 200–300 words and must be respectful and evidence-based.