fractures

Question 1

what is an open fracture ?

Answer 1

direct communication between fracture an external environment
not always skin - pelvis fracture can go into rectum

Question 2

why are open fractures important ?

Answer 2

higher energy injury
increased infection rate
soft tissue complications
long term morbidity

Question 3

what are the most common sites for open fractures ?

Answer 3

tibial shaft

finger

Question 4

what are the different types of open fractures ?

Answer 4

type 1 - wound <1cm, clean, simple
type 2 - wound >1cm, moderate tissue damage, adequate skin cover
type 3 - extensive soft tissue damage, complex fracture pattern, any mental injury
3A - adequate perisosteal cover
3B - tissue loss requiring coverage
3C - vascular injury needing repair

Question 5

what is the grading for open fractures ?

Answer 5

Gustilo grading

Question 6

what is the most common type of open fracture ?

Answer 6

type 3B - 30%

1 - 24%
2- 22%
3A - 22%
3C - 4%

Question 7

how do you manage an open fracture ?

Answer 7

ATLS assessment
tetanus and Abx (clindamycin + gentamicin) prophylaxis
remove gross contamination
radiographs
support

Question 8

what are indications for urgent surgery (within 6 hours) ?

Answer 8

polytraumatised patient
marine/farmland environment
gross contamination
neuromuscular compromise
compartment syndrome

Question 9

what is the surgical management of an open fracture ?

Answer 9

debridement
fixation
definitive skin coverage - plastic surgeon
amputation

Question 10

what are indications for an amputation ?

Answer 10

insensate limb/foot
irretrievable soft tissue or bony damage
other life threatening injury