American Board of Surgical Assistants (ABSA) Orthopedic Practice Test

Which injury is most likely to cause shock in a patient?

1. Bimalleolar fracture/dislocation

2. Pelvic fracture

3. Impacted femoral neck fracture

4. Femoral shaft fracture

The correct answer is: Pelvic fracture

A pelvic fracture is most likely to cause shock in a patient due to the significant potential for massive hemorrhage associated with injuries to the major blood vessels that run through the pelvis, including the internal iliac arteries. Since the pelvis is a central structure in the body, any fracture can disrupt vascular integrity, leading to rapid blood loss and, consequently, hypovolemic shock. Injuries like a bimalleolar fracture/dislocation, while serious, typically do not involve major vascular structures to the same extent as pelvic fractures. An impacted femoral neck fracture is also concerning, particularly regarding potential complications and reduced blood supply to the femoral head, but the overall risk of acute shock is lower compared to pelvic injuries. A femoral shaft fracture can lead to significant blood loss as well, but again, the primary threat in pelvic fractures is their association with major vascular compromise, which directly contributes to the likelihood of shock occurring.