Fractures - Classification and management

Question 1

Open fracture
-definition
-classification
-management

Answer 1

Disrupted bony cortex + broken overlying skin

Gustilo and Anderson
1 - low energy wound U1cm
2 - 1cm+ wound + moderate soft tissue damage
3 - high energy wound + 1cm+ + extensive tissue damage
3A - adequate soft tissue coverage
3B - inadequate soft tissue coverage
3C - arterial injury

Initial
-examine for associated injuries and extent
-control bleeding
-medical photography
-NV status
-cover wound with dressing and ABx
-early debridement and irrigation in theatre
-stabilise with external fixation or internal fixation

Question 2

Internal vs external fixation
-when is each one used

Answer 2

Internal
-displaced open fracture
-risk of malunion
-failed closed reduction

External - used more often in trauma
-displaced open fracture
-high infection risk
-considerable bone loss at fracture site

Question 3

Paediatric fractures
-types and management

Answer 3

Buckle - bulging of cortex in long bone
-5-10 year olds
-self limiting, splint, immobilisation