Mini Symposium: Fractures 2 (Open fractures and dislocations)

Question 1

what Is the definition of an open fracture?

Answer 1

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

Question 2

In Gustilo grading define a type 1 Open Fracture…

Answer 2

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

Question 3

In Gustilo grading define a type 2 Open Fracture…

Answer 3

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

Question 4

In Gustilo grading define a type 3 Open Fracture…

Answer 4

Type III -
high energy, extensive soft tissuedamage,
severe fracture (comminution,displacement), wound >10cm; any gunshot, farm accident, segmental fracture, bone loss, severe crush injury, marine
IIIA - soft tissue damage +++ but not grossly contaminated
IIIB - periosteal stripping, extensive muscle damage, heavy contamination
IIIC - assoc. neurovascular complication

Question 5

Mx of an open fracture

Answer 5

Full ATLS assessment and primary surgical treatment - wound debridement/excision and skeletal stabilization
tetanus and antibiotic prophylaxis - Cefuroxime / Augmentin / Clindamycin- 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 including joint above and below

Question 6

what would indicate emergency surgery within 6 hours of presentation?

Answer 6

Polytraumatised patient, Marine or Farmyard environment, Gross contamination, Neurovascular compromise, Compartment syndrome

Question 7

what are the 4 c’s of surgical fixation and debridement?

Answer 7

colour, contraction, consistency, capacity to bleed.

Question 8

common dislocation direction and appearance of the shoulder

Answer 8

Direction = Ant. Post. 
Apprearance = Squared off, Locked in internal rotation

Question 9

common dislocation direction and appearance of the elbow

Answer 9

Post.

Olecranon prominent post.

Question 10

common dislocation direction and appearance of the Hip

Answer 10

Post.

Leg short, flexed, internal rotation, adduction

Question 11

common dislocation direction and appearance of the Knee

Answer 11

Anteropost.

Loss of normal contour, extended

Question 12

common dislocation direction and appearance of the Ankle

Answer 12

Lat. more common

Externally rotated, prominent med. Malleolus

Question 13

common dislocation direction and appearance of the Subtalar joint

Answer 13

Lat. more common

Lat. displaced os calcis