open fractures

Question 1

what is an open fracture

Answer 1

direct communication between external environment and fracture
usually break through skin but not always
higher energy
increased infection rate
soft tissue complications
can be distracting from other injuries

Question 2

most problematic/ common open fracture

Answer 2

tibial shaft. usually type IIIB

Question 3

gustilo classification of open fracture

Answer 3

type 1 wound <1cm
type 2. >1 cm
type 3 A - soft tissue damage but not grossly contaminated
3B- periosteal stripping, muscle damage, heavy contamination
3C- neurovascular complication

type 3 any farm accident, marine, bone loss, segmental fracture, gunshot, crush injury

Question 4

management of open fractures

Answer 4

ATLS assessment
tetanus and antibiotic prophylaxis
repeated neurovascular status
remove gross contamination, photograph, cover and stabilise limb
radiographs including joint ABOVE AND BELOW

Question 5

patients with early surgery requirements

Answer 5

polytrauma
marine or farmyard
gross contamination
neurovascular compromise
compartment syndrome
otherwise just normal working hours

Question 6

criteria for muscle viability (the four C’s)

Answer 6

colour
contraction on being pinched
consistency
capacity to bleed

deciding what to debride and fixate

Question 7

scoring for amputation includes

Answer 7

age
sensation
shock
mechanism of injury
vascular- pulses and temp etc