Open Fractures

Question 1

What is an open fracture?

Answer 1

There is a direct communication between the external environment and the fracture, usually through a break in the skin

Question 2

When would an open fracture not be through the skin?

Answer 2

Through the GI tract ie fragments from a fractured pelvis penetrating the rectum

Question 3

Why are open fractures important?

Answer 3

Higher energy injury
Increased infection rate
Soft tissue complications
Long term morbidity

Question 4

What are the most common sites of open fracture?

Answer 4

Fingers

Tibial shaft

Question 5

What is a type 1 open fracture?

Answer 5

Clean wound of <1cm

Simple fracture pattern

Question 6

What is a type 2 open fracture?

Answer 6

Wound>1cm, moderate soft tissue damage, adequate skin coverage, simple fracture pattern

Question 7

What is a type 3 open fracture?

Answer 7

Extensive soft tissue damage, complex fracture pattern
3A - adequate periosteal coverage
3B - Tissue loss requiring soft tissue coverage procedure ie graft
3C - vascular injury requiring repair

Question 8

What are fracture patterns for open tibial fracture?

Answer 8

A - transverse or short oblique tibial fractures with fibular fractures at a similar level
B - Tibial fractures with comminution/butterfly fragments with fibular fractures at similar level
C - Segmental tibial fractures
D - Fractures with bone loss

Question 9

What are soft tissue injury patterns in open tibial fracture?

Answer 9

A - Skin loss such that direct tension-free closure is not possible following wound excision
B - Degloving
C - Injury to muscles which requires excision of devitalised muscle via wound extension
D - Injury to one or more of major arteries of leg

Question 10

How is open fracture managed?

Answer 10

Full ATLS assessment and treatment
Tetanus and antibiotic prophylaxis
Triple antibiotic therapy
Repeated examination and nausea/vomiting status
Wounds handled only to remove gross contaminents
Photograph, cover, and stabilise limb
No provisional irrigation
Radiographs

Question 11

What are factors for emergency urgent surgery?

Answer 11

Polytraumatic patient
Marine or farmyard equipment
Gross contamination
Neurovascular compromise
Compartment syndrome

Question 12

What are the 4 C’s for surgical debridement of open fractures?

Answer 12

Colour
Contraction
Consistency
Capacity to bleed

Question 13

When should amputation be considered?

Answer 13

Insensate limb/foot
Irretrievable soft tissue or bony damage
Other life threatening injuries