Open fractures

Question 1

What region is most at risk for open fracture?

Answer 1

At or distal to the tarsus.

Question 2

What are some risk factors for development of open fracture?

Answer 2

Increased age, increased body weight, comminuted fracture, motor vehicle trauma.

Question 3

What are the grades outlined by the Gustilo-Anderson open fracture classification scheme?

Answer 3

Type 1: open fracture with wound smaller than 1cm.
Type II: open fracture with wound larger than 1cm but intact soft tissues.
Type IIIa: open wound with significant soft tissue disruption but adequate coverage.
Type IIIb: open fracture with extensive soft tissue loss.
Type IIIc: neurovascular damage requiring repair

Question 4

What pressure is initial wound lavage performed at?

Answer 4

7-8 psi (1L fluid bag in a pressure sleeve with the pressure raised to 300 mmHg)

Question 5

What antimicrobial treatment is recommended based on GusAnderson-open fracture grade

Answer 5

Types I and II: first or second generation cephalosporin.
Types III: cephalosporin and fluoroquinolone

Question 6

What percentage of open fracture infections are caused by the organism cultured at the time of initial presentation?

Answer 6

8%

Question 7

What bacteria are most commonly isolated from initial wound cultures?

Answer 7

Staph, strep, klebsiella, pseudomonas, e-coli, enterobacter, clostridium

Question 8

What are the goals of treatment for open fracture management?

Answer 8

1. Prevent infection.
2. Promote bony union.
3. Repair soft tissue damage.
4. Restore function.

Question 9

What are some methods that may be used to facilitate early soft tissue coverage of open fractures?

Answer 9

Vacuum assisted closure (NPWT), pedicle muscle transfers, microvascular free muscle transfers, subdermal plexus flaps, axial pattern flaps, free skin grafts.

Question 10

What are potential benefits of external fixation in the treatment of open fractures?

Answer 10

Decreased application time, location of implants away from the fracture site, easy access for open wound management, minimal disruption of tissues during application, and implant removal that is relatively easily accomplished

Question 11

Can a cancellous bone graft be used in an infected fracture site?

Answer 11

Yes. Cortical bone grafts cannot be used as may form a sequestra.

Question 12

In a study by Schrock 2022 in VCOT, what factor was associated with an increased likelihood of a poor outcome following gunshot fractures in dogs and cats? What were the most common post-operative complications?

Answer 12

Extensive soft tissue trauma was associated with an increased likelihood of a poor outcome. The most frequent poor outcome being amputation.

The most common complications were osteomyelitis, SSI, and delayed/non-unions.