Open Fractures Flashcards
What are the 3 goals of open fracture treatment?
Convert contaminated wounds to clean wounds
Early soft tissue healing
Stabilize fractures
Gustillo and Anderson classify open fractures based on what 4 things?
Mechanism
Level of contamination
Configuration
Soft tissue damage
Describe a Type 1 G&A open fracture
Patient has a simple fracture that produced a clean puncture wound less than 1 cm. There is little soft-tissue damage
Describe a Type 2 G&A open fracture
Patient presents with open fracture that has produced a laceration greater than 1 cm. You decide the there is moderate contamination as well as moderate comminution.
Describe a Type 3A G&A open fracture
Patient presents with extensive laceration and severe comminution. The soft tissue is okay
Describe a Type 3B G&A open fracture
Patient presents with open fracture that has massive contamination. There is extensive soft tissue loss. Periosteal stripping has occurred. Severe comminution present.
Describe a Type 3C G&A open fracture
Patient presents with an open fracture that results in arterial injury/damage
Open fractures are a?
Surgical Emergency
What is the most important initial step of treating an open fracture?
Irrigation and Debridement in the OR
With open fractures, what do you typically do after the initial I&D and surgery
Delayed closure
What is the typical length of time for when abiding by limited duration of therapy when using antibiotics?
48-72 hours
What antibiotic should you use in clostridium prone wounds?
PCN G
G&A Type 1 open fractures typically require what antibiotic therapy?
Cefazolin
-2 gm IV every 8 hours
G&A type 2 and 3 open fractures require what antibiotic therapy?
Cefazolin
Aminoglycosides
-3-5 mg/kg/day
What are 3 indications for amputation
Uncontrolled sepsis
Necrosis/gangrene
Primary amputation
