Open Fractures

Question 1

Definition of Open Fractures

Answer 1

Direct communication between the external environment and the fracture. There is usually a break in the skin.

Question 2

Prevalence of Open fractures

Answer 2

23/100,000 per year

Question 3

Main causes of open fractures

Answer 3

Fingers and tibial shaft fractures

Question 4

Amount of polytraumatised patients with open fractures

Answer 4

2/3rds

Question 5

Type 1 open fracture

Answer 5

Wound <1cm, clean and simple fracture pattern

Question 6

Type 2 open fracture

Answer 6

Wound >1cm, moderate sift tissue damage, adequate skin coverage and simple fracture pattern

Question 7

Type 3 open fracture

Answer 7

Extensive soft-tissue damage, complex fracture patten.

Question 8

Type 3A

Answer 8

Adequate periosteal coverage

Question 9

Type 3B

Answer 9

Tissue loss requiring soft tissue coverage

Question 10

Type 3C

Answer 10

Vascular injury requiring repair

Question 11

Percentage of type 1

Answer 11

24

Question 12

Percentage type 2

Answer 12

22%

Question 13

Percentage 3A

Answer 13

22

Question 14

Percentage 3B

Answer 14

30

Question 15

Percentage 3C

Answer 15

4

Question 16

Management of open fractures

Answer 16

• Full ATLS assessment and treatment
• Tetanus and antibiotic prophylaxis
• Cefroxime/augmentin/clindamycin and gentamicin at the time of fixation
• Repeated examination
• Wounds only handled to remove gross contamination
• Photograph, cover and stabilise the limb
• No provisional irrigation/exploration
• Radiographs

Question 17

Surgical debridement and fixation of open fractures

Answer 17

This is conducted by an experienced surgeon

Colour
Contraction
Consistency
Capacity to bleed