Fractures: Basics, Healing and Complications

Question 1

what is an open fracture?

Answer 1

direct communication between the external environment and the fracture. usually through a break in the skin but could also be fragments of bone from a fractured pelvis penetrating the rectum

Question 2

what accounts for 50% of open fractures?

Answer 2

fingers

tibial shaft

Question 3

describe type I open fracture according to Gustilo grading

Answer 3

low energy
would < 1 cm
clean
often bone piercing skin from inside

Question 4

describe type II open fracture according to Gustilo grading

Answer 4

moderate soft tissue damage
wound < 10 cm
no soft tissue flap or avulsion

Question 5

describe type III open fracture according to Gustilo grading

Answer 5

high energy, extensive soft tissue damage
severe fracture (communution, displacement)
wound > 10cm
any gunshot, farm accident, segmental fracture, bone loss, severe crush injury, marine

Question 6

describe type IIIa open fracture according to Gustilo grading

Answer 6

soft tissue damage +++ but not grossly contaminated

Question 7

describe type IIIb open fracture according to Gustilo grading

Answer 7

periosteal stripping
extensive muscle damage
heavy contamination

Question 8

describe type IIIc open fracture according to Gustilo grading

Answer 8

associated neurovascular complication

Question 9

what type of open fracture is most common?

Answer 9

IIIb

Question 10

management of open fractures

Answer 10

full ATLS assessment and treatment
tetanus and antibiotic prophylaxis
cefuroxime/augmentin/clindaymicin -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 inc joint above and below

Question 11

what is the 6 hour rule for surgery in an open fracture?

Answer 11

polytrauma
marine or farmyard environment
gross contamination
neurovascular compromise
compartment syndrome

Question 12

if someone does not fit into the 6 hr criteria when should emergency surgery be carried out?

Answer 12

within normal working hours and within 24 hrs

Question 13

4 C’s for surgical debridement in open fracture

Answer 13

colour
contraction
consistency
capacity to bleed

Question 14

types of skin coverage for open fracture

Answer 14

SSG
myofasciocutaneous
fasciocutaneous
rotation
free flaps

Question 15

decision to amputatr

Answer 15

dual consultant
insensate lib/foot
irretrievable soft tissue or bony damage
other life threatening injuries
Guillotine type and refashion at a later stage

Question 16

define dislocation

Answer 16

complete joint disrupton

Question 17

define subluxation

Answer 17

partial disolocation - lot fully out of joint

Question 18

diagnosis of dislocation

Answer 18

clinical and radiological

Question 19

assessment of dislocation

Answer 19

associated injuries - soft tissue, musculoskeletal, multi-system
associated #, n/v damage, pre op

Question 20

direction and deformity associated with dislocations: shoulder

Answer 20

ant - squared off

post - locked in internal rotation

Question 21

direction and deformity associated with dislocations: elbow

Answer 21

post

olecranon prominent post

Question 22

direction and deformity associated with dislocations: hip

Answer 22

post

leg short, flexed, internal rotation, adduction

Question 23

direction and deformity associated with dislocations: knee

Answer 23

anteroposterior
loss of normal contour
extended

Question 24

direction and deformity associated with dislocations: ankle

Answer 24

lat
exernally rotated
prominent med. malleolus

Question 25

direction and deformity associated with dislocations: subtalar joint

Answer 25

lat

lat displaced os calcis

Question 26

what may the outcomes of a dislocation be?

Answer 26

recurrent instability and stiffness