open fracture management (#2) Flashcards
Most common sites?
Fingers and tibial shafts
1/3 polytrauma patients have
a “distracting open fracture”
gustillo classification again
1 -> small wound (less than 1cm), clean, bone piercing from the inside.
2 -> simple fracture, wound 1-10cm. Moderate soft tissue damage, no tissue flap or avulstion
3 -> complex fracture (displacement/comminuted), marine/farm, gunshot, segmental fracture, bone loss, severe crush, marine) (a = not grossly contam. B = periosteal stripping/heavy contamination, c = associated neurovascular complications)
Qho operates on them?
Specialist multidisciplinary team, ideally at first instance so that the same team can come back in if there are any issues etc.
What are the soft tissues criteria?
A-> skin lost so won’t can’t close tension free following excision
b -> degloved,
c-> muscles need to be removed
d = major artery involvement
Prophylaxis abx are what?
Cefuroxime, aufmentin, clindamycin/gentamycin
management in ed - what?
ATLS assessment, tetnus and antibiotics, continual assessment of neurovascular status. Gross contamination removed, photographed and covered with saline swabs. Serilize the limb.
Indications for urgent surgery (within 6 hours)
-marine/farm
-polytraumatixed
-neurovascular compromise
-gross contamination
-compartment syndrome
What is debridement decided by?
The smart cookies, specialist ortho surgeons. They look at the:
Colour of muscles etc, contraction of muscles, consistency, capacity to bleed. Ideally want to do all debridements in one go.
Types of skin grafts can use:
SSG (split skin graft), Myofasciocutaneous (muscle, fascia and skin), fasciocutaneous (fascia and skin), rotation and free flaps.
Who decides if the limb is salvageable?
2 specialist orthopaedic surgeons. Based on other life threatening injuries (in which case you “Giollotine” approach -> cut it off at lowest level and deal with it later). In cases of insensate limb/foot, irretrievable/irreversiable soct tissue or bondy damage.
