Chapter 87 - Gunshot Wounds and Open Fractures

Question 1

Kinetic energy of a bullet is equal to what?

Answer 1

1/2 *(mass * velocity squared)

Question 2

four categories of entrance wounds

Answer 2

contact: blackened, seared margins, the muzzle is physically on the skin

near-contact: powder soot deposits

intermediate: gunpowder tattooing

distant

Question 3

pathophysiology of lead toxicity after gsw

Answer 3

synovial fluid is caustic to lead components causing localized plumbism, producing severe synovitis
macrophages can phagocytose lead particles causing systemic lead toxiity

Question 4

when to CT periarticular fractures

Answer 4

AFTER spanning ex fix, if no spanning ex fix is planned before definitive fixation then at least after reduction

Question 5

special antibiotic circumstances

Answer 5

• gram negative coverage: aaminoglycoside (eg gentamicin)
• farm or soil contamination: penicillin
• fresh/saltwater: fluoroquinolone

Question 6

Outcomes of wounds managed with wound vac vs wet to dry dressings?

Answer 6

lower infection rate
shorter hospital stays
(for wound vac’d injuries)

Question 7

when should an open injury get a flap?

Answer 7

within 7 days (ideally five)

Question 8

when do growth factors peak in masquelet technique?

Answer 8

6 weeks after spacer placement

Question 9

limb salvage vs amputation outcomes?

Answer 9

similar functional outcomes
limb salvage more likely to be re-hospitalized, underwent more surgeries, and more likely to have a major complication