Open Fractures

Question 1

Periosteal stripping is evidence of what Type of open fracture?

Answer 1

Type III; automatic Type III are also segmental injuries, high velocity projectiles

Question 2

What type of open injuries are given special consideration?

Answer 2

1) Exposure to soil
2) fresh, tepid or salt water injuries
3) Barnyard injuries
4) Bite injuries

Question 3

What are the typical abx used in open fractures?

Answer 3

Type I, II- 1st gen ceph (ancef 1-2g q8h); can also use clindamycin or vancomycin if allergic
Type III- 1st gen ceph and aminoglycoside (gentamicin 1-5mg/kg q8h)
Barnyard- add PCN (4 million U q8h) and gent
Saltwater/Freshwater- Fluoroquinolone (Levaquin or cipro)
If PCN allergic can give fluoroquinolones
Can give ceftazadime or doxycycline for saltwater injuries

Question 4

What is the quick version of the Gustilo Anderson classification for open fractures?

Answer 4

Type I- wound 10 cm, high energy
adequate tissue for coverage
includes segmental or extensively comminuted fractures even if wound