Management Of Open Fractures Flashcards
Principles of management
• Prevention of _______
• Soft tissue ______ and ________
• Restoration of anatomy
• Functional recovery
• Essence of treatment is early return to normal function
infection
healing; bone union
Classification of open fracture
• Gustilo - Anderson classification
• Type -1_____________
• Type 2- _____________
• Type 3- __________
• Type 3A- wound ___________
• Type 3B- wound ____________
•type 3C - associated with _____________
wound less than 1 cm
wound greater than 1cm but less than 10cm
wound greater than 10cm
can be closed
can not be closed
neural or vascular injury
Stages of care
• A. initial assessment __________ and ___________
• B. primary operations
-staged / _________________
- fracture ____________
•C. Secondary operations
- ________________________
- ____________________
•D Rehabilitation
resuscitation and A&E MGT
radical debridement ; stabilization
skin and soft tissue reconstruction
bone reconstruction
Emergency management of open fractures
•_________________ -30% have associated injuries
• Clinical __________
• ?Wound _____
• Remove ______________ and apply moist sterile dressing (betadine if available)
ATLS resuscitation
photograph; swab
gross contamination
Emergency management of open fractures
• Antibiotics (give ASAP)
• - Gustillo Anderson I- give ___________________
• - Gustillo Anderson 2 & 3 - give _________________________
• Add antibiotics for ___________ if it was a farm injurvor contact with stagnant water or pool.
1st or 2nd generation cephalosporin
Cephalosporin + aminoglycosides.
anaerobes
vascular injury - repair should within __________ of injury
6 hours
Wound debridement involves Copious wound irrigation with ________ (UP TO ________)
Normal saline
10 Litres
Primary operation: Wound debridement and fracture stabilization
• Pressure irrigation - ___________
• Final irrigation with fluid containing ___________
•___________ or _________ for m/c/s
• Vascular repair
• In staged debridement, repeat in 48 7-2 hours
pulsed lavage; antibiotics
Wound biopsy or wound swab
Secondary operation soft tissue reconstruction
•Type I- ________
• TypeIL& IIIA - ____________
• Type IIIB and IIIC -Need of ______ including _________
left to heal
delayed primary closure
flaps
composite flaps
_______ and _________ follow inadequate or delayed soft tissue &bone reconstruction
Delayed and non union
Disruption of the __________ nerve with an __________ or a __________ injury with a warm ischaemia time of over ___________ is an ABSOLUTE INDICATION FOR PRIMARY AMPUTATION.
posterior tibial ; insensate sole
severe crush; 6 hours
