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Flashcards in Open Fractures Deck (20)
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1
Q

Open fractures

A

There is a direct communication between the external environment and the fracture usually through a break in the skin (but not always)

2
Q

Why are open fractures important?

A
  • Higher energy injury
  • Increased infection rate
  • Soft tissue -Complications
  • Long term morbidity
3
Q

What is the epidemiology of open fractures?

A
  • 23 per 100,000 popu. per year
  • Fingers + tibial shaft account for >50%
  • Probably about 3,500 open tibial shaft fractures in UK per year
  • 1/3 of polytraumatised patients have open fractures- distracting injuries
4
Q

How are open fractures classified?

A

Gustilo classification of open fractures

  • Type 1
  • Type 2
  • Type 3
5
Q

What is a type 1 open fracture?

A

Wound <1cm, clean, simple fracture pattern

6
Q

What is a type 2 open fracture?

A

Wound >1cm, moderate soft tissue damage, adequate skin coverage, simple fracture pattern

7
Q

What is a type 3 open fracture

A

Extensive soft-tissue damage, complex fracture pattern

  • 3A: adequate periosteal coverage
  • 3B: Tissue loss requiring soft-tissue coverage procedure (such as a flap or a graft)
  • 3C: Vascular injury requiring repair
8
Q

What is the epidemiology of open tibial shaft fractures?

A
  • Type I: 24%
  • Type II: 22%
  • Type IIIA: 22%
  • Type III B: 30%
  • Type IIIC: 4%
9
Q

What is the historical treatment principles of open fractures?

A
  • Preservation of life
  • Preservation of limb
  • Avoidance of infection
  • Rehabilitation of function
10
Q

What are the principles recommendations for modern open fracture treatment?

A
  • MDT approach
  • Hospitals lacking staff or equipment have a contingency plan
  • Primary surgical treatment takes place at specialist centre
  • Specialist centres organised on a regional basis
11
Q

Give examples of fracture patterns.

A
  • Transverse or short oblique tibial fractures with fibular fractures at a similar level
  • Tibial fractures with comminution/butterfly fragments with fibular fractures at a similar level
  • Segmental tibial fractures
  • Fractures with bone loss, either from extrusion at the time of injury or after debridement
12
Q

Give examples of soft tissue injury patterns.

A
  • Skin loss such that direct tension-free closure is not possible following wound excision
  • Degloving
  • Injury to the muscles which requires excision of devitalised muscle via wound extensions
  • Injury to one or more of the major arteries of the leg
13
Q

How are open fractures managed before treatment?

A

-Full ATLS assessment and treatment
-Tetanus and antibiotic prophylaxis
-Cefuroxime / Augmentin / Clindamycin- Gent at time of fixation
-Repeated examination neurovascular status
-Wounds only handled to remove gross contamination,
photograph, cover (saline swabs) and stabilise limb
-No provisional irrigation / exploration
-Radiographs- orthogonal views including joint above and below

14
Q

Who is the 6 hour surgical rule pertinent for?

A
  • Polytraumatised patient
  • Marine or Farmyard environment
  • Gross contamination
  • Neurovascular compromise
  • Compartment syndrome
15
Q

Who does the 6 hour rule not apply to?

A

Solitary open fractures

16
Q

What are the 4Cs of surgical debridement?

A
  • Colour
  • Contraction
  • Consistency
  • Capacity t bleed
17
Q

What is multiple debridements associated with?

A

Poorer outcomes

18
Q

What techniques can be used for definitive skin coverage?

A
  • SSG
  • Myofasciocutanoeus
  • Fasciocutaneous
  • Rotational
  • Free flaps
19
Q

The decision to amputate is based on…

A
  • Limb ischaemia?
  • Patient age
  • Shock?
  • Injury mechanism
20
Q

When is amputation considered?

A
  • Insensate limb or foot
  • Irretrievable soft tissue or bony damage
  • Other life threatening injuries