Open fractures

Question 1

Define an open fracture

Complications of open fracture

Principles of management and outcome of fractures and dislocations, including conservative and surgical management

Answer 1

.

Question 2

Open fracture =

Answer 2

direct communication between the external environment and the fracture

Question 3

Complications of open fracture

Answer 3

Infection

Soft tissue complications?

Question 4

Most common open fractures occur where (2)

Answer 4

Fingers

Tibial shaft

Question 5

Name the classification system for open fractures

Answer 5

Gustilo classification

Question 6

Describe the gustilo classification system for open fractures

• type I
• type II
• type III

Answer 6

Type I - low energy, wound <1cm, clean

Type II - moderate soft tissue damage, wound >1cm

Type III - high energy, extensive soft tissue damage, wound >10cm

Question 7

Principles of management of open fracture (6)

Answer 7

Full ATLS (Advanced trauma life support) assessment

Tetanus + antibiotic prophylaxis

Repeated examination

Photograph, cover + stabilise limb (fixation)

NO IRRIGATION (i.e. saline) OF WOUND

X-ray

Question 8

Indications for emergency urgent surgery (4)

Answer 8

Polytraumatised
Marine or farmyard contamination
Neurovascular compromise
Compartment syndrome

Question 9

Surgical management to consider for open fractures

Answer 9

Surgical debridement

Skin graft/ flap