Open Fractures

Question 1

First steps to manage

Answer 1

Take a picture, Antibiotics (1.2g co-amoxiclav), Analgesia (Morphine 5mg)

Irrigate the area and cover in saline dressing to avoid sticking

Splint for stabilisation, pain relief and preventing haemorrhage

=> Surgery

Question 2

What is the name of the classification for open fractures

Answer 2

Gustilo and Anderson Grades 1-3C
1 - <1cm
2 - >1cm
3C - vascular involvement

Question 3

Open fracture with vascular compromise?

Answer 3

Immediate surgery

Question 4

What is compartment syndrome

Answer 4

Increased pressure in a closed fascial place which causes muscle ischaemia

Caused by bleeding, muscle swelling

Common in LL tibial leg fractures, flexor compartments, crush injuries (stuck under bus - can be delayed)

Question 5

How to diagnose compartment syndrome

Answer 5

Clinical diagnosis

To CONFIRM a diagnosis - measure compartment pressures (30-40 mmHg)

Question 6

Clinical features of compartment syndrome

Answer 6

Pain is unresponsive to analgesia (morphine)

Pain on passive muscle stretching, parasthesia, tightly swollen compartment, shiny skin

untreated => critical ischaemia (6 P’s)

Question 7

Management of compartment syndrome

Answer 7

Emergency fasciotomy - all fascial envelopes open for days to allow swelling to expand