O P E N F R A C T U R E

Question 1

what is the classification of open fracture protocol

Answer 1

• gustilo-anderson classification
• type 1= less than 1cm sized wound and clean
• type 2 = 1-10cm wound and clean
• type 3a - greater than 10cm, tissue in tact
• type 3b = greater than 10cm with soft tissue involvement
• type 3c = vascular injury

Question 2

what should you examine for?

Answer 2

• neurovascular status

- overlaying skin for skin and tissue loss

Question 3

describe the outcomes of open fractures

Answer 3

• skin - smalll wound - significant tissue loss
• soft tissue damage
• neurovascular injury - nerves and vessels can be compressed due to limb deformity - arteriospasm
• infection - high rate (direct contamination, reduced vascularity, systemic compromise)

Question 4

lx required in open fractures

Answer 4

• FBC, group and save, clotting screen
• plain film radiograph
• CT for comminuted or complex fractures

Question 5

management of open fractures

Answer 5

• resus and stabilisation
• realignment and splinting
• reassess NV status following realignment or reduction
• IV antibiotic
• tetanus vaccination
• photograph wound and remove gross debris
• saline -soaked gauze to wash out

Question 6

what is the definitive management?

Answer 6

• requires debridement

- if vascular compromise - get vascular surgeon exploration

Question 7

• what is compartment syndrome?

Answer 7

critical pressure increase within a confined compartment

- any fascial compartment can be affected

Question 8

pathophysiology of compartment syndrome

Answer 8

• usually occurs following high-energy trauma, crush injuries, vascular injury + iatrogenic, tight casts or splints, post-perfusion swelling
• fascial compartments closed and cannot be distended
• fluid deposited causes increase in intra-compartmental pressure
• pressure increases causes vein compression
• causing increase in hydrostatic pressure causing fluid out of veins into compartment - further increases pressure
• transversing nerves compressed - causing sensory or and motor deficit
• parasthesia is a common sx
• intra-compartment pressure reaches diastolic BP, arterial inflow compromised - ischaemia (cool, pale,pulseless, paralysed limb) - late sign of missed compartment syndrome

Question 9

compartment syndrome clinical features

Answer 9

• • sx present within hours - up to 48hrs post-insult
  • severe pain disproportionate to injury (not improved by analgesia, elevation of limb, splitting cast)
  • pain made worse by passive stretching muscle bellies of muscle transversing affected fascial compartment
  • parasthesia

Question 10

compartment syndrome required

Answer 10

• clinical diagnosis
• intra-compartmental pressure used to monitor
• CK can aid diagnosis

Question 11

how is compartment syndrome managed

Answer 11

• urgent fasciotomy
• keep limb at neutral levels
• high flow oxygen
• opioid analgesia

Question 12

what should be monitored in this condition? what are the complications of this syndrome?

Answer 12

renal function - potential effects of rhabdomyolysis or reperfusion injury