OPEN FRACTURE

Question 1

Open fracture

Answer 1

• occurs when the bone breaks through the skin
• typically result from high-energy injuries and are often associated with significant damage to the surrounding soft tissues and contamination of the wound

Question 2

Gustillo Anderson Type I

Answer 2

low energy and wounds are usually < 1 cm

0-2 % - infection

1st gen cephalosporin - CEFAZOLIN 1 g q8 x 48 hrs after each debridement

Question 3

Gustillo Anderson Type II

Answer 3

wound length of 2 to 10 cm with moderate soft tissue damage and wound contamination

2-7 % - infection

1st gen cephalosporin PLUS aminoglycoside

CEFAZOLIN 1 g q8 hrs AND
AMINOGLYCOSIDE 3-5 mg/kg/day x 72 hrs after each debridement

Question 4

Gustillo Anderson Type III

Answer 4

high-energy wounds usually > 10 cm in length with extensive muscle devitalization

wound is highly contaminated with extensive soft tissue damage

IIIa - severe crushing w/ adequate coverage

IIIb - severe loss of coverage w/c will require reconstruction

IIIc - severe loss of coverage w/c may require reconstruction
-vascular injury which requires repair

1st gen cephalosporin, PLUS aminoglycoside PLUS penicillin

CEFAZOLIN 1 g q8 hrs AND
AMINOGLYCOSIDE 3-5 mg/kg/day and
PENICILLIN 2 M units q4 hrs OR METRONIDAZOLE, 500 mg q6 hrs x 72 hrs after each debridement