Open Fractures Flashcards
Define an open fracture?
Direct communication between the external environment and the fracture
Common areas for open fractures?
Fingers and tibial shaft
Classification for open fractures?
Gustilo
Gustilo type 1
Wound <1cm,
Clean,
Simple fracture pattern,
Bone piercing skin from inside
Gustilo Type 2
Wound >1cm,
Moderate soft tissue damage,
Adequate skin coverage,
Simple fracture pattern
Gustilo Type 3
Extensive soft tissue damage,
Complex fracture pattern,
3A- adequate periosteal coverage,
3B- extensive muscle damage, Tissue loss requiring soft-tissue coverage procedure
3C- neuromuscular complication assoc, vascular injury requiring repair
Guidelines used for open fracture treatment
BOAST
Types of fracture patterns
Transverse or short oblique tibial/ fibular fracture,
Comminution/ butterfly fragments,
Segmental tibial fractures,
Fractures with bone loss
Soft tissue injury patterns
A-skin loss such that direct tensio-free closure isn’t possible
B- degloving
C- injury to muscles which requires excision of devitalised muscle
D- Injury to one or more of the major arteries of the leg
Management of open fracture
ATLS assessment and treatment, Tetanus and antibiotic prophylaxis, Cefuroxime, Augmentin, clindamycin, Photograph, cover and stabilise limb, Surgical debridement and fixation
Indications for emergency urgent surgery, 6 hour rule?
Polytraumatised patient, Marine or farmyard environment, Gross contamination, Neuromuscular compromise, Compartment syndrome
Types of definitive skin coverage
SSG, Myofasciocutaneous, Fasciocutaneous, Rotation, Free flaps
Indications for amputation of open fracture
Dual consultant decision,
Insensate limb/foot,
Iorretrievable soft tissue or bony damage,
Other life threatening injuries,
