Open fractures Flashcards
Gustilo Anderson Classification
I - up to 1cm soft tissue damage with minimal energy trauma - clean
II - 2- 10cm cm moderate energy trauma - clean
III - 10+ cm or high energy trauma
IIIa - adequate soft tissue coverage of bone - orthopaedics alone
IIIb - bony exposure needs coverage - plastic input
IIIc - neurovascular compromise - vascular input
Mx
ATLS Associated injuries - e.g. head injuries Analgesia Tetanus vaccination + Abx Assess NV status X-ray Realign + recheck NV status + X-ray Remove gross debris + Take picture
Soft tissue mx - saline gauze dressing/ debridement
Fixation
History
HPC - How - When - Where - farm, marine-grade III as contamination risk - What - When did pt last eat - Hand dominance - if upper limb PMHx - previous surgeries DHx - allergies and anticoagulants SHx - smoking, occupation and whole live with
Examination
Circumferential inspection
Neurosvascular examination
Treatment of soft tissue
Initial evaulation
Wound covered and limb splinted
Tetanus injection
Abx within 3 hours of injury - co - amoxiclav
Debridement and irrigation in OT with plastics
Photo documentation
Fixation
When should soft tissue coverage be done
within 72 hrs of injury
Mx of grade III fractures
Temporary fixation using external fixation for soft wound coverage
Then definitive fixation after e.g. plate or nails to decrease infection risk
Risks of surgery
Non union Malunion Delayed union PE/DVT Infection Anaesthetic risk Loss of limb Scarring
Preparation before surgery
NBM
Tetanus
Test - FBC, clotting
Post op instructions
Generally:
4 - 6 weeks - non-weight bearing
After 6 weeks can weight bear with continuous Xrays
MESS
mangled extremity score - whether amputation is necessary - 7+
GANGA hospital score
Wound management guidelines
Skin Score 1 - 2 - suture
Skin score 3 - 4 - early or delayed flap
Skin score 5 - reconstruction
Investigations
Bloods - FBC, U+Es, LFTS, clotting, Group + save, mismatch
X-ray in 2 views
When is immediate debridement needed
Contaminated with marine, agricultural or sewage material
When should debridement be done if not contaminated
Within 24 hours
