Open fractures Flashcards
What is an open fracture?
Direct communication between outside world and fracture site
Usually via skin, but nit always
Can be large or small wound
What are the issues associated with open fractures?
High energy injury
Increased infection rate
Soft tissue complications
Long term morbidity
Where are open fractures most often seen?
Fingers or tibial shaft
What is the classification system?
Gustilo
What is a type 1 open fracture?
Wound <1cm
What is a type 2 open fracture?
Wound 1-10cm
What is a type 3 open fracture?
Wound >10cm or
a- extensive soft tissue damage
b- extensive soft tissue damage, periosteal stripping and heavy contamination
c- associated neurovascular injury
What are the types of fracture patterns?
Transverse/oblique
Butterfly fragments
Segmental
Bone loss fracture
What are the types of soft tissue injury patterns?
Skin loss
Degloving
Injury to muscles
Injury to neurovascular structures
What are the key principles of treatment?
Identify Resus with ADTL guidelines Antibiotics and tetanus prophylaxis Wound only handled to remove gross contamination Photograph Cover with saline swabs and stabilise limb Radiographs Primary surgical treatment
What are the indications for urgent surgery in open fracture?
Polytraumatised patient Marine or farmyard environment Gross contamination Neurovascular compromise Compartment syndrome
How soon should surgery be performed in open fracture?
Indications for urgent- 6 hours
If not- 24 hours
What are the 4 Cs of tissue viability?
Colour
Contraction
Consistency
Capacity to bleed
What are the types of surgery for an open fracture?
Debridement
Fixation- temporary or definitive
Skin coverage
Amputation
What are the indications for amputation in open fracture?
Insensate limb/foot
Irretrievable soft tissue or bony damage
Other life threatening injuries
