open fractures

Question 1

what is an open fracture?

Answer 1

‘open’ when there is a direct communication between the fracture site and the external environment.

usually through skin but pelvic fractures may be internally open through vagina or rectum.

Question 2

what are the two different types of open fractures?

Answer 2

in-to-out = sharp bone ends penetrate the skin from beneath

out-to-in = high energy injury penetrates the skin, traumatising the subtending soft tissues and bone

Question 3

what are the outcomes of an open fracture in terms of

• skin
• soft tissue
• Neurovascular supply
• Infection

Answer 3

skin = coverage may not be achieved without aid of plastics e.g skin graft or free flap.

soft tissue = depends, may need reconstructive surgery.

NV injury =may become compressed, go into spasm or be dissected.

infection = high rate due to direct contamination, reduced blood supply, systemic compromise an potential need for metalwork for stability.

Question 4

what are the clinical features of an open fracture?

Answer 4

• pain
• swelling
• deformity
• overlying wound or punctum

make sure to asses NV status.

Question 5

what investigations should be done for open fractures?

Answer 5

• blood tests, including clotting screen and group and save

- plain film radiograph of affected area also

Question 6

what is the management for an open fracture?

Answer 6

• resuscitate and stabilise
• urgent realignment and splint
• reassess NV status following any realignment or reduction
• broad spectrum antibiotic cover should be done and a tetanus vaccine if patient hasn’t received it already
• remove any gross debris, take a photo of it so dont need to reopen wound then dress with saline soaked gauze

Question 7

what is the definitive management for an open fracture?

Answer 7

• debridement of the wound
• wash out wound with saline
• ensure skeleton stabilisation
• consult vascular surgeon is there is vascular compromise or if soft tissue cover required consult plastics.