Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Orthobullets Trauma > Open Fracture Management > Flashcards

Open Fracture Management Flashcards

1
Q

what are open fractures?

A

fractures with direct communication to the external environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

fractures with direct communication to the external environment

A

open fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

most common location for open fractures

A

tibia and finger phalanx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

associated conditions

A

additional injuries (30%)
compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

percentage of open fractures associated with additional injuries

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the presence of an open wound does not preclude the occurrence of _____ in the injured limb

A

compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

the size and nature of the external wound may not reflect the damage to the ____ structures

A

deeper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

if concern for vascular insult, _____ should be obtained

A

ankle brachial index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

normal ABI ratio

A

<0.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

vascular surgery consult and angiogram is warranted if ABI < ____

A

0.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what do you do if ABI is <0.9

A

vascular consult and angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

consider ______ if concern for traumatic arthrotomy

A

saline load test or CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

consider saline load test or CT scan if concern for _____

A

traumatic arthrotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

radiographs to obtain

A

obtain radiographs including joint above and below fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

peri-articular injuries
evaluation for traumatic arthrotomy of the knee

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CT indications

A

peri-articular injuries
evaluation for traumatic arthrotomy of the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

nonoperative treatment includes:

A

urgent IV antibiotics, tetanus prophylaxis, and extremity stabilization and dressing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

nonoperative indications

A

initial treatment for all open fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

a _____ should be treated as an open fracture until proven otherwise

A

soft tissue wound in proximity to a fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

a soft tissue wound in proximity to a fracture should be treated as ____ until proven otherwise

A

an open fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

operative management types

A

I&D, temporary fracture stabilization, local antibiotic administration and soft tissue coverage
definitive reconstruction and fracture fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

consider ____ as soon as possible
ideal time of soft tissue coverage controversial, but most centers perform within 5-7 days

A

I&D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

consider I&D as soon as possible
ideal time of soft tissue coverage controversial, but most centers perform within ____ days

A

5-7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

infection rates of open fracture depend on _____, periosteal stripping and delay in treatment

A

zone of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

infection rates of open fracture depend on zone of injury, _____ and delay in treatment

A

periosteal stripping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

infection rates of open fracture depend on zone of injury, periosteal stripping and _____

A

delay in treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

incidence of fracture-related infection range from _____% in type I open fractures to 30% in type III fractures

A

<1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

incidence of fracture-related infection range from <1% in type I open fractures to _____% in type III fractures

A

30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

indications for definitive reconstruction and fracture fixation

A

once soft tissue coverage is obtained and an adequate sterility is achieved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

definitive treatment with internal fixation leads to significantly decreased _____, improved functional outcomes, and decreased time in the hospital compared to those definitively fixed with external fixation

A

time to union

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

definitive treatment with internal fixation leads to significantly decreased time to union, improved ____ outcomes, and decreased time in the hospital compared to those definitively fixed with external fixation

A

functional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

when should antibiotics be initiated

A

as soon as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

studies show increased infection rate when antibiotics are delayed for more than ____ hours from time of injury

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

continue antibiotics for 24 hours after initial injury if wound is able to be _____

A

closed primarily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

continue antibiotics for 24 hours after final closure if _____

A

wound is not closed during initial surgical debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

antibiotics for Gustilo type 1 and 2

A

1st generation cephalosporin

clindamycin or vancomycin can also be used if allergies exist

37
Q

antibiotics for gustilo type 3

A

1st generation cephalosporin + aminoglycoside
some institutions use vancomycin + cefepime

38
Q

antibiotics for farm injuries, heavy contamination, or possible bowel contamination

A

add high dose penicillin for anaerobic coverage (clostridium)

39
Q

add high dose penicillin for anaerobic coverage (clostridium)

A

farm injuries, heavy contamination, possible bowel contamination

40
Q

antibiotics for fresh water wounds

A

fluoroquinolones or 3rd or 4th generation cephalosporin

41
Q

antibiotics for salt water wounds

A

doxycycline + ceftazidime or a fluoroquinolone

42
Q

when to initiate tetanus prophylaxis

A

in the ED or trauma bay

43
Q

tetanus toxoid and immunoglobulin should be given intramuscularly with ____ different syringes in ____ different locations

A

two

44
Q

guidelines for tetanus prophylaxis depend on 3 factors

A

complete or incomplete vaccination history (3 doses)
date of most recent vaccination
severity of wound

45
Q

methods of stabilization

A

splint, brace, or traction for temporary stabilization
decreases pain, minimizes soft tissue trauma, and prevents disruption of clots

46
Q

remove gross debris from wound, do not remove any _____

A

bone fragments

47
Q

place sterile _____ dressing on wound

A

saline soaked

48
Q

recent meta-analysis (____ study) have recommended debridement within 24 hours to minimize risk of infection for type III fractures

A

goliath

49
Q

recent meta-analysis (GOLIATH study) have recommended debridement within ____ hours to minimize risk of infection for type III fractures

A

24

50
Q

recent meta-analysis (GOLIATH study) have recommended debridement within 24 hours to minimize risk of infection for type ____ fractures

A

3

51
Q

recommended debridement within
within ____ hours for type IIIB open tibia fractures

A

12

52
Q

recommended debridement within
within 12 hours for type ____ open tibia fractures

A

3B

53
Q

taged debridement and irrigation
perform every ____ hours as needed

A

24-48

54
Q

I&D technique: extend wound ____ in line with extremity to adequately expose open fracture

A

proximally and distally

55
Q

low-pressure bulb irrigation vs. high-pressure pulse lavage

A

no difference in infection or union rates

56
Q

studies have shown that saline with ____ had decreased primary wound healing problems when compared to antibiotic solutions

A

Castile soap

57
Q

how many liters of saline for Gustilo type 1?

A

3

58
Q

how many liters of saline for gustilo type 2?

A

6

59
Q

how many liters of saline for gustilo type 3?

A

9

60
Q

thorough ____ of devitalized tissue is critical to prevent deep infection

A

debridement

61
Q

bony fragments without ____ attachments should be removed

A

soft tissue

62
Q

bony fragments without soft tissue attachments should be ____

A

removed

63
Q

performed at the time of initial debridement

A

temporary fracture stabilization

64
Q

____ is temporary initial treatment of choice for majority of high energy open fractures of the lower extremity

A

external fixation

65
Q

significantly contaminated wounds with large soft tissue defects
large bony defects

A

local antibiotics

66
Q

indications for local antibiotics

A

significantly contaminated wounds with large soft tissue defects
large bony defects

67
Q

local antibiotics technique

A

beads made by mixing methylmethacrylate with heat-stable antibiotic powder
vancomycin and tobramycin most commonly used

68
Q

local antibiotics: beads made by mixing ____ with heat-stable antibiotic powder
vancomycin and tobramycin most commonly used

A

methylmethacrylate

69
Q

most commonly used antibiotic powder in local antibiotic treatment

A

vancomycin and tobramycin

70
Q

timing of flap coverage for open tibial fractures remains controversial, < _____ days is desired

A

7

71
Q

soft tissue coverage: odds of infection increase by ____% for each day beyond day 7

A

16

72
Q

soft tissue coverage: odds of infection increase by 16% for each day beyond day ____

A

7

73
Q

studies have not shown any statistical difference between rate of ___ when ORIF is performed before fasciotomy closure, at fasciotomy closure, or after fasciotomy closure

A

infection

74
Q

can proceed with bone grafting after wound is ____

A

clean and closed

75
Q

_____ wound therapy may be utilized during debridement until definitive coverage can be achieved

A

negative-pressure

76
Q

Definitive reconstruction and fracture fixation if no critical bone defect:

A

open reduction and internal fixation or intramedullary treatment depending on fracture location and morphology

77
Q

definitive reconstruction and fracture fixation if critical bone defect:

A

Masquelet technique (“induced-membrane” technique)
distraction osteogenesis
vascularized bone flap/transfer

78
Q

Masquelet technique 1st stage

A

I&D, cement spacer and temporizing fixation

79
Q

Masquelet technique 2nd stage

A

placement of bone graft into “induced membrane” and definitive fixation

80
Q

Studies show optimal time frame for bone grafting to be _____ weeks after placement of cement spacer

A

4-6

81
Q

complications of open wounds

A

surgical site infection
osteomyelitis
Neurovascular injury
Compartment syndrome

82
Q

osteomyelitis incidence ranges between ______% depending on the bone involved and fracture characteristics

A

1.8% to 27%

83
Q

the most common site of post-surgical osteomyelitis following surgical treatment of open fractures

A

tibia

84
Q

blast mechanism of injury
acute surgical amputation
delay in defintive soft tissue coverage greater than 7 days
more severe Gustillo-Anderson classification.

A

osteomyelitis risk factors

85
Q

osteomyelitis risk factors

A

blast mechanism of injury
acute surgical amputation
delay in defintive soft tissue coverage greater than 7 days
more severe Gustillo-Anderson classification.

86
Q

To minimize risk of infection, debridement recommended to be performed within ____ hours for all type III fractures and within 12 hours for type IIIB open tibia fractures

A

24

87
Q

To minimize risk of infection, debridement recommended to be performed within 24 hours for all type III fractures and within ____ hours for type IIIB open tibia fractures

A

12

88
Q

Infection rates higher in open injuries due to blunt or penetrating trauma?

A

blunt

89
Q

____ rates higher in open injuries due to blunt trauma than penetrating trauma

A

infection

Orthobullets Trauma (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions