Open Fractures Flashcards
What is an open fracture?
It’s is fracture that has direct communication between the fracture site and external environment. Most often through the skin but pelvic fracture can penetrate through vagina/rectum.
What are the two mechanisms of an open fracture?
“in to out”
“out to in”
What are the common sites of open fractures?
Tibial, phalangeal , forearm, ankle and metacarpal
What 4 things apart from the fracture should be consider in an open fracture?
Skin
Soft tissues
Neurovascular supply
Infection
What should you do during examination of an open fracture?
Check neurovascular status
Check for evidence of contamination - marine, agriculture and sewage contamination is of the highest importance
Who should be involved if vascular damage or significant skin/soft tissue damage was suspected?
Vascular surgeon
Plastic surgeon
What classification system is used for open fractures?
Gustilo-Anderson classification
What are the classifications for open fractures?
Type 1: <1cm wound and clean
Type2: 1-10 cm wound and clean
Type 3A: >10cm wound and high energy, with adequate soft tissue coverage
Type 3B: >10cm wound and high energy, with inadequate soft tissue coverage
Type 3C: All injuries with vascular injury
What investigations are required for open fractures?
Basic bloods including clotting screen and G&S
Plain film radiograph
For very comminuted or complex pattens CT-scan can often as diagnosis
CXR
CT trauma series in high trauma cases
What is the management for open fractures?
Resuscitation and stabilisation
Realignment an splinting - document neurovasular status after
Broad spec antibiotics
Check tetanus vaccination status - last 5-10 years
Remove any gross debris and photograph wound - saline-soaked gauze + occlusive dressing
Analgesics and anti-emetics
What is the definitive management of open fractures?
Debridgement of the wound and the fracture site + washout fixation
Immediate if contaminated with marine, agriculture or sewage material
Otherwise <12-24 hrs in other case
Ensure skeletal stabilisation and appropriate input form plastics and vascular
What are the signs of compartment syndrome?
Tense/tight compartment
Pain of passive stretching
Analgesia doesn’t help
Pain not proportional to injury
Could investigate by measuring compartmental pressure by intra-compartment pressure monitor
Latter signs: 5Ps/6Ps, Rasied CK,
What is the initial management for compartment syndrome before theatre?
Take cast off relive pressure High flow O2 NBM - fluids Baseline obs + bloods Analgesia
What is the definitive for compartment syndrome?
Urgent fasciotomy
What is AMPLE?
Allergies Medication PMH Last meal Events happened during the trauma
