open fractures

Question 1

caused by

Answer 1

either caused by a spike of bone penetrating the skin from within (‘inside out injury’) or due to laceration of the skin from tearing or penetrating injury (‘ outside in injury’)

Question 2

what increases the risk of infection

Answer 2

• the greater the energy of injury
• the degree of contamination
• any delay in treatment
• problems with wound closure

Question 3

what increases risk of amputation

Answer 3

concomitant vascular injury

Question 4

what classification is used for open fractures

Answer 4

GUSTILO classifciation

Question 5

what does this classification encompass

Answer 5

degree of contamination, size of wound, whether the wound can be closed, is there concomitant vascular injury

Question 6

initial management

Answer 6

IV broad spectrum antibiotics

Question 7

broad spectrum cover

Answer 7

• flucloxacillin for gram positives
• gentamicin for gram negatives
• metronidazole to cover anaerobes if there is soil contamination

Question 8

what should be applied before fracture is splinted

Answer 8

sterile dressings

Question 9

further management

Answer 9

requires surgical debridement as soon as possible to remove all contamination and excise any non-viable tissue

Question 10

what are open fractures usually stabilised with post-surgery

Answer 10

internal or external fixation