41: Trauma Symposium Lectures - Open Fractures, Principles of Management

Question 1

what is an open fracture?

Answer 1

There is a direct communication between the external environment and the fracture.
Usually through a break in the skin, not always,
e.g. fragments of bone from a fractured pelvis penetrating the rectum

Question 2

outline the management of an open fracture

Answer 2

• full ATSL assessment and treatment
• tetanus and antibiotic prophylaxis
• Cefuroxime/Augmentin/Clindamycin- Gent at time of fixation
• repeated examination n/v status
• wounds only handled to remove gross contamination
• photograph, cover (saline swabs) and stabilise limb
• no provisional irrigation/exploration
• radiographs - orthogonal views
• surgical debridement and fixation

Question 3

when does the 6 hour rule apply for performing surgery for open fractures?

Answer 3

• polytraumatised patient
• marine or farmyard environment
• gross contamination
• neurovascular compromise
• compartment syndrome