Open Fractures Flashcards
1
Q
ESSENCE
A
Fractures with direct communication to external environment
2
Q
EPIDEMIOLOGY
Most common bones
A
Finger phalanynx and tibia most common
3
Q
AETIOLOGY
Most common cause
A
- High injury trauma
4
Q
CLINICAL FEATURES
Presentation
A
- Can see open fracture
- Obtain information about mechanism, location and timing of injury
- Pain
- Swelling
- Deformity
5
Q
What are important associated injuries
A
- Compartment syndrome
- Skin wounds - plastics input
- Soft tissue damage
- Neurovascular injury
- Infection
6
Q
What classification system is used
A
Gustilo-Anderson classification
7
Q
Describe Gustilo-Anderson classification
A
- Type 1
- <1cm and clean
- Type 2
- 1-10cm and clean
- Type 3A
- >10cm and high energy, but with adequate soft tissue coverage
- Type 3B
- >30cm and high energy, but inadequate soft tissue coverage
- Type 3C
- All injuries with vascular injury
8
Q
Simple summary of management guide for 3A, B and C
A
A - ortho alone
B - requires plastics input
C - vascular input
9
Q
INVESTIGATIONS
First choice
A
- Basic bloods including clotting screen
- X-ray affected area
- CT for complex fractures and to aid management
10
Q
MANAGEMENT
General principles
A
- Resuscitation and stabilisation
- Urgen realignment and splinting of limb
- Broad spectrum antibiotics and up to date tetanus vaccination
- Dress wound with saline-soacked gauze prior to definitive management
- Definitive management
11
Q
MANAGEMENT
Definitive management
A
- Surgical management
- Debridement of wound and fracture site
- Should happen immediately if contaminated with marine, agricultural or sewage material, <24 hours in other cases
- Wound washed out with volumes of saline
- Surgical exploration of vascular compromise
12
Q
MANAGEMENT
Antibiotic choice
A
- For gustilo 1 and 2
- 1st generation cephalosporin
- Clindamycin or vancomycin in allergies
- For gustilo 3
- 1st generation cephalosporin and aminoglycoside
- If farm injuries or other contamination
- Add high dose penicillin for anaerobic coverage
