Open fracture

Question 1

What are open fractures?

Answer 1

A fracture that is open- when there is direct communication between the fracture site and the external environment, usually through the skin but pelvic fractures can go through vagina or rectum

Question 2

What is in to out injury?

Answer 2

there the sharp bone ends penetrate the skin from beneath

Question 3

What is out to in injury?

Answer 3

where high energy injury penetrates the skin traumatising subtending soft tissues and bone

Question 4

What are the most common fractures to become open?

Answer 4

Tibial, phalangeal, forearm, ankle and metacarpal

Question 5

What do the outcomes of an open fracture depend on?

Answer 5

Skin, soft tissue, neuromuscular injury, infection

Question 6

What needs to be considered in regards to the skin in an open fracture?

Answer 6

very small wound or significant tissue loss, may need plastic surgery e.g. skin grafting or a local/free flap

Question 7

What needs to be considered in regards to soft tissue in an open fracture?

Answer 7

may have little devitalisation to significant musle/tendon/ligament loss requiring reconstructive surgery

Question 8

What needs to be considered in regards to neuromuscular injury in an open fracture?

Answer 8

nerves and vessels may be compressed due to limb deformity, go into arteriospasm, develop and intimal dissection or be transected altogether

Question 9

What needs to be considered in regards to infection in an open fracture?

Answer 9

due to direct contamination, reduced vascularity, systemic compromise and need for insertion of metalwork for fracture stabilisation

Question 10

What is the first thing you need to do for someone with an open fracture?

Answer 10

Initial resuscitation

Question 11

How will patients present with an open fracture?

Answer 11

pain, swelling and deformity with overlying wound or punctum

Question 12

What should be checked for on examination with an open fracture?

Answer 12

neurovascular status and overlying skin for any skin or tissue loss, contamination

Question 13

What contamination of an open fracture must be documented?

Answer 13

marine, agricultural, sewage

Question 14

What is the Gustilo- Anderson classification type 1?

Answer 14

smaller than 1cm wound and clean

Question 15

What is the Gustilo- Anderson classification type 2?

Answer 15

1-10cm wound and clean

Question 16

What is the Gustilo- Anderson classification type 3A?

Answer 16

> 10cm wound and high energy, but with adequate soft tissue coverage

Question 17

What is the Gustilo- Anderson classification type 3B?

Answer 17

> 10cm wound and high energy but with inadequate soft tissue coverage

Question 18

What is the Gustilo- Anderson classification type 3C?

Answer 18

all injures with vascular injuries

Question 19

How can 3A-3C be managed?

Answer 19

3A= orthopaedics, 3B=Plastics 3C= vascular

Question 20

What investigations are needed for someone with an open fracture?

Answer 20

Blood tests, clotting screen and group and save, plain film radiograph

Question 21

What is the management for an open fracture?

Answer 21

Resuscitation, stabilisation, realignment, splinting, broad spectrum antibiotics, tetanus, photograph the wound, remove any gross debris, wound dressed with saline soaked gauze, debridement of the wound and fracture site, if contaminated then immediately and if not then in less than 24 hours