10.1. Fractures - Open Fractures Flashcards
What is the definition of an “Open Fracture”?
There is a direct communication between the External Environment and the Fracture
Usually through a break in the skin but not always
What is the significance of an Open Fracture?
- Higher Energy Injury
- Increased Risk of Infection
- Soft-Tissue Complications
- Long-Term Moridity
Note - 1/3 of Polytraumatised patients have open fractures
What are the most common bones for Open Fractures to occur in?
- Fingers
2. Tibial Shaft
What are the Classifications of Open Fractures?
- Type 1 - Open Fractures
- Type 2 - Open Fractures
- Type 3 - Open Fractures
What are the Features of a Type 1 Open Fracture?
- Low-Energy
- Wound < 1 cm
- Clean
- Simple Fracture Pattern - Bone piercing skin from inside
What are the Features of a Type 2 Open Fracture?
- Moderate Soft-Tissue Damage
- Wound < 10cm
- No Soft-Tissue Flap / Avulsion
- Adequate Skin Coverage
- Simple Fracture Pattern
What are the Features of a Type 3 Open Fracture?
- High Energy
- Extensive Soft-Tissue Damage
- Severe Fracture (Communication Displacement)
- Wound > 10cm
What are the different Subtypes of a Type 3 Open Fracture?
3A - Soft Tissue Damage +++, but not grossly contaminated
3B - Periosteal Stripping, Extensive Muscle Damage, Heavy Contamination
3C - Associated Neurovascular Complication
What are the different Fracture Patterns, in a Tibial Fracture?
A) Transverse / Short Oblique Tibial Fractures with Fibular Fractures at a Similar Level
B) Tibial Fractures with Communication / Butterfly Fragments with Fibular Fractures at a Similar Level
C) Segmental Tibial Fractures
D) Fractures with Bone Loss
What are the Soft-Tissue Injury Patterns, in a Tibial Fracture?
A) Skin Loss such tat Direct Tension-Free Closure is not possible following Excision
B) Degloving
C) Injury to the Muscles which requires Excision of Devitalized Muscle via Wound Extensions
D) Injury to 1+ of the Major Arteries of the Leg
What is the immediate Management of a Complex Open Fracture?
- Full Advanced Trauma Life Support (ATLS) Assessment and Treatmen
- Tetanus and Antibiotic Prophylaxis - Cefuroxime / Augmentin / Gentamycin
- Repeated Neurovascular Status Examinatuon
- Wounds only handled to remove Gross Contamination
- No provisional Irrigation / Exploration
What are the indications for Emergency Surgery?
- Polytraumatised Patients
- Marine / Farmyard Environment
- Gross Contamination
- Neurovascular Compromise
- Compartment Syndrome
Note - 6 hour rule
What is looked at for Surgical Debridement and Fixation?
4 C’s:
- Colour
- Contraction
- Consistency
- Capacity to Bleed
Who takes responsibility for Skin Coverage?
Plastic Surgeons - “Rob Peter to pay Paul” Principle
When is Amputation considered?
- Dual Consultant Decision
- Insensate Limb / Foot
- Irretrievable Soft Tissue / Bony damage
- Other Life-Threatening Injuries
