Mini symposium - fractures 1

Question 1

Define open fracture

Answer 1

There is a direct communication between the external environment and the fracture

Question 2

What is usually meant by an open fracture? what else can it be?

Answer 2

break in the skin

bone fragment from fractured pelvis rupture rectum

Question 3

4 reasons open fractures are important

Answer 3

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

Question 4

Name of classification for open fractures

Answer 4

gustilo

Question 5

type 1 open fracture

Answer 5

wound less than 1cm, clean, simple fracture pattern

Question 6

type 2 open fracture

Answer 6

more than 1cm, less than 10cm, simple fracture pattern, moderate soft tissue damage and adequate skin coverage

Question 7

type 3 open fracture

Answer 7

extensive soft tissue damage, complex fracture pattern

Question 8

3A open fracture

Answer 8

adequate periosteal coverage

Question 9

3B open fracture

Answer 9

tissue loss requiring soft tissue eg graft

Question 10

3C open fracture

Answer 10

vascular injury requiring repair

Question 11

Give some examples of causes of type 3 open fractures

Answer 11

gunshot wound
marine
farming injury

Question 12

epidemiology of open fractures - most common and %

Answer 12

type 1 = 24%
type 2 = 22%
3A = 22%
3B = 30%
3C = 4%

Question 13

4 historical treatments of open fractures

Answer 13

preserve life
preserve limb
avoid infection
rehab

Question 14

4 fracture patterns

Answer 14

transverse or short oblique tibial with fibular fracture at similar level
tibial fracture with butterfly fragments and fibular fracture at similar level
segmental tibial fractures
fractures with bone loss from extrusion at time of injury or after debridement

Question 15

4 soft tissue injury patterns

Answer 15

skin loss - direct tension free closure not possible
degloving
injury to muscles - need excision of devitalised muscle via wound extensions
injury to one or more major arteries in leg

Question 16

Management of open fractures

Answer 16

tetanus and antibiotic prophylaxis
gross contamination removed and photograph
cover with saline swabs
stabilise limb
radiographs - orthogonal view with joint above and below

Question 17

5 indications for emergency surgery in open fractures

Answer 17

polytraumatised patient 
marine or farmyard environment 
gross contamination 
neurovascular compromise
compartment syndrome

Question 18

4 C’s of surgical debridement and fixation

Answer 18

colour
capacity to bleed
contraction
consistency

Question 19

List some sources of definitive skin coverage

Answer 19

myofasciocutaneous
rotation
free flaps
fasciocutaneous

Question 20

4 categories for amputation decision

Answer 20

shock
limb ischaemia
injury mechanism
age

Question 21

Reasons for amputation

Answer 21

2 consultant decision
insensate limb/foor
irretreivable soft tissue or bony damage
other life threatening injuries
guillotine type and refashion at later stage

Question 22

dislocation

Answer 22

complete joint disruption

Question 23

subluxation

Answer 23

partial - not fully out of joint

Question 24

Diagnosing dislocation

Answer 24

clinical and radiological - x-ray (ligament and capsule damage)
associated injuries eg neurovascular, soft tissue
recurrent instability

Question 25

deformity of anterior and posterior shoulder dislocation

Answer 25

ant = squared off 
post = locked in internal rotation

Question 26

deformity of posterior elbow dislocation

Answer 26

olecranon prominent posteriorly

Question 27

deformity of posterior hip dislocation

Answer 27

short leg, flexed, internal rotation, adducted

Question 28

deformity of anteropost. knee dislocation

Answer 28

loss of normal contour, extended

Question 29

deformity of lateral ankle dislocation

Answer 29

externally rotated

prominent medial malleolus

Question 30

deformity of lateral subtalar joint dislocation

Answer 30

laterally displaced os calcis (heel bone)