1. treatment of the open fractures, guidelines, methods

Question 1

What is the definition of an open fracture?

Answer 1

A fracture of a bone where there is an open skin wound near the fractured bone. The wound is usually caused from the inside by the bone.

Question 2

What should be examined in an open fracture?

Answer 2

• Circulation distal to the fracture (pulse, CRT)
• Sensation distal to the fracture
• Motor function distal to the fracture

Question 3

How should open fractures be managed initially?

Answer 3

1. ABCDE
2. Immobilization
3. Irrigation & debridement
4. Analgesia
5. Antibiotics
6. Consider tetanus prophylaxis

Question 4

What are the risks of an open fracture?

Answer 4

Malunion / Non-union
Osteomyelitis
Fat embolization
Thromboembolism
Arterial damage
Nerve damage

Question 5

What is the antibiotic treatment for osteomyelitis?

Answer 5

• Ciprofloxacin
• Vancomycin
  Consider:
• Cefazolin(1st gen)
• Metronidazole

Question 6

How are open fractures classified?

Answer 6

I. < 1cm wound size
II. 1 - 10 cm wound size with good soft tissue coverage

III.
a) Open fracture with some soft tissue coverage (extensive soft tissue damage) ALSO farm & gunshot injuries
b) Open fracture with little soft tissue coverage (periosteal stripping)
c) arterial injury requiring repair regardless of anything else

Question 7

How are open fractures treated definitively?

Answer 7

Surgery (debridement, fixation)
Amputation if it is impossible to rescue the limb