Flashcards in Open Fractures Deck (20)
There is a direct communication between the external environment and the fracture usually through a break in the skin (but not always)
Why are open fractures important?
-Higher energy injury
-Increased infection rate
-Soft tissue -Complications
-Long term morbidity
What is the epidemiology of open fractures?
-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
How are open fractures classified?
Gustilo classification of open fractures
What is a type 1 open fracture?
Wound <1cm, clean, simple fracture pattern
What is a type 2 open fracture?
Wound >1cm, moderate soft tissue damage, adequate skin coverage, simple fracture pattern
What is a type 3 open fracture
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
What is the epidemiology of open tibial shaft fractures?
-Type I: 24%
-Type II: 22%
-Type IIIA: 22%
-Type III B: 30%
-Type IIIC: 4%
What is the historical treatment principles of open fractures?
-Preservation of life
-Preservation of limb
-Avoidance of infection
-Rehabilitation of function
What are the principles recommendations for modern open fracture treatment?
-Hospitals lacking staff or equipment have a contingency plan
-Primary surgical treatment takes place at specialist centre
-Specialist centres organised on a regional basis
Give examples of fracture patterns.
-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
Give examples of soft tissue injury patterns.
-Skin loss such that direct tension-free closure is not possible following wound excision
-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
How are open fractures managed before treatment?
-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
Who is the 6 hour surgical rule pertinent for?
-Marine or Farmyard environment
Who does the 6 hour rule not apply to?
Solitary open fractures
What are the 4Cs of surgical debridement?
-Capacity t bleed
What is multiple debridements associated with?
What techniques can be used for definitive skin coverage?
The decision to amputate is based on...