Open Fracture Flashcards
What is the initial management of an open fracture? (6)
Rapid A-E assessment
Tetanus prophylaxis (toxoid & human antiserum)
Antibiotics - co-amoxiclav (clindamycin if penicillin allergic)
Inspect and photograph wound
Control bleeding
Keep covered until in theatre
What classification can be used for open fractures?
Gustilo’s
What is type 1 Gustilo’s?
Small, clean wound with little soft tissue damage
What is type 2 Gustilo’s?
A moderate-energy fracture with a clean wound more than 1cm long
What is type 3 Gustilo’s?
A high-energy fracture with extensive skin, soft tissue and neurovascular damage and wound contamination.
What type of fixation is used for which Gustilo types?
ORIF - Types 1 & 2
External fixation - Type 3
What are the three types of Gustilo type 3 open fractures?
3a - fractured bone can be adequately covered by muscle or skin
3b - extensive periosteal stripping and fracture cover is not possible
3c - arterial injury which needs to be repaired, regardless of extent of soft-tissue damage
Surgical management of open fracture (4)
Antibiotic prophylaxis
Prompt wound debridement
Fracture stabilisation
Early definitive wound cover
What is used for additional antibiotic cover?
Gentamicin added to second dose of first antibiotic (co-amoxiclav or clindamycin) to cover Gram neg species
What antibiotics are used as a single dose at time of definitive wound cover?
Gentamicin and vancomycin (effective against Staph and Pseudomonas infection)
How long should antibiotics be used?
Minimum of 72 hours
Up to 7-10 days
Why is debridement necessary?
Prevention of compartment syndrome and infection
What is used for wound cleansing?
Saline
3 things not to forget about wound cleansing
Don’t inject syringes of fluid through a small aperture
Adding Abx to saline has no additional benefit
Do not suture cut nerves or tendons
How do you close a grade 1 or 2 fracture?
Suturing after debridement
