Open Fractures

Question 1

What is an open fracture?

Answer 1

• direct communication between the external environment and the fracture
• usually through a break in the skin

Question 2

What is the relevance of an open fracture?

Answer 2

• higher energy injury
• inc. infection rate
• soft tissue complications
• long term morbidity

Question 3

What is the incidence of open fractures?

Answer 3

• 23/100,000/yr
• finger and tibial shafts > 50 %

Question 4

What is the Gustilo Classification of Open Fractures?

Answer 4

• type 1- wound < 1cm, clean, simple fracture pattern
• type 2- wound > 1cm, mod soft tissue damage, adequate skin coverage, simple fracture pattern
• type 3- extensive soft tissue damage, complex fracture pattern

Question 5

What is the treatment for open fractures?

Answer 5

• full ATLS assessment + treatment
• tetanus + antibiotic prophylaxis
• cefuroxime, augmentin, clindamycin
• repeated examination n/v status
• wounds only handled to remove gross contamination
• photograph, cover (saline swabs), stabalise limb
• no provisional irrigation/exploration
• radiographs- orthogonal views, inc. joint above + below