Open Fracture Flashcards
What is an open fracture?
There is a direct communication between the external environment and the fracture.
Why are open fractures important?
- High infection rate
- Can have soft tissue complications
- Long term morbidity
What is the vast majority of open fractures?
- Fingers + tibial shaft account for >50%
What does polytraumatised mean?
- One person with multiple sites of trauma
What is the classification for open fractures?
Gustilo Classification
- Type 1: small <1cm
- Type 2: medium >1cm
- Type 3: large (extensive damage)
(apparently this is common exam question)
What makes a good classification system?
- System specific
- Allows for accurate detail
- Will aid in the management of patients
What are the guidelines for managing open fractures?
BOAST 4
Please give an overview of BOAST 4.
- A multidisciplinary team, including orthopaedic and plastic surgeons with appropriate experience, is required for treatment of complex open fractures
- Send to hospitals who have appropriate expertise and fascilities
- The primary surgical treatment should take place at specialist centre
What are some fracture patterns?
- Transverse or short oblique tibial fractures
- Tibial fractures with butterfly fragments with fibular fractures at similar level
- Segmental
- Fractures with bone loss
What is the management of open fracture?
- Full ATLS [advanced trauma life support] assessment and treatment
- Tetanus and antibiotic prophylaxis
- Cefuroxime / Augmentin / Clindamycin- Gent at time of fixation
- Repeated examination
- Wounds only handled to remove gross contamination, take photo and then cover up
- Radiographs
Indications for emergency urgent surgery? 6 hour rule?
Only 6hr rule if list below applies:
- Polytraumatised patient
- Marine or Farmyard environment
- Gross contamination
- Neurovascular compromise
- Compartment syndrome
What is surgical debridement?
Removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue
What are the indications for surgical debridement and excision?
4 Cs (carried out by experienced surgeons)
- Colour
- Contraction
- Consistency
- Capacity to bleed
What are is the role of external fixators?
If surgery cannot be performed there and then, general rule is to stabilise everything - role of external fixators.
What is SSG?
What is free flap?
- SSG: split skin graft
- Free flap: take skin/muscle from elsewhere
What are the requirements for amputation?
See image. (i can’t be hooped copying it out)
