Test 1: open fixation Flashcards
what is an open fracture
Fracture of the bone with exposure to the environment
All contaminated, but not all infected or will become
infected
type 1 open fracture
small <1 cm wound
low energy trauma: simple fracture
minimal soft tissue damage
small amount of wound contamination
low infection and complication rate
type II open fracture
> 1 cm
usually external trauma: outside to inside
mild to moderate soft tissue damage
simple or comminuted fracture
moderate contamination
type III open fracture
extensive soft tissue damage with devitalization
major contamination
high energy trauma: gun shot
lots of pieces
outside to inside trauma
Type IIIa open fracture
Adequate soft tissue coverage for fractured bone despite an extensive laceration or ST flaps
No major reconstructive procedures
type IIIb open fracture
ST loss and inadequate ST coverage with periosteal
stripping and exposure of bone
Type IIIc open fracture
Extensive ST damage with damage to the arterial blood supply
- Arterial blood supply must be repaired to salvage limb
most open fractures become infected —
in the hospital (nosocomial)
need to cover open wounds with sterile dressing to prevent contamination and soft tissue damage
goal of initial wound management
remove dead or dirty material
make clean wound with adequate blood supply
lavage, debridement, sterile bandage
debridement rules
can remove most fat and fascia
but more conservative with muscle and skin
things like bone, ligaments and tendons should try to be preserved
wait and see approach- might need staged debridements
when to give antibiotics for wounds
start ASAP, get culture first
give IV drugs for 72 hours
type 1 open fractures should use what antibiotic
−Usually involve contamination with aerobic, gram positive bacteria
−1st generation cephalosporins
(Cefazolin/Cephalexin)
type II and III open fractures should use — antibiotics
broad spectrum: gram + or gram -
advantages of ex fix
gives easy access to wound
pins can be removed easily
decreases damage to soft tissue
when to use bone grafting
type I and II
can use autogenous cancellous bone graft at same time as repair
type III
delayed grafting- 4-6 weeks post repair
when to do bandage changes
more frequently for worse wounds
should use sterile technique
debridement and lavage as needed
osteomyelitis
Inflammatory condition
affecting bone (periosteum, cortex, & medullary canal) usually due to an infectious cause such as bacterial, fungal, or occasionally viral
what is post traumatic osteomyelitis
infection secondary to surgery
on implant
how to cause osteomyelitis
ischemic event (trauma or surgery)
bacterial colonization:
-Hematogenous
-Direct inoculation*
-Contiguous infection
what are some systemic factors that lead to infection
§ Hypovolemia
§ Malnutrition
§ Obesity
§ Endocrine diseases
§ Immunosuppression
what are some local factors that lead to bone infection
Unstable fracture
Tissue metabolism
Foreign material
Dead space
bacterial glycocalyx
Network of polysaccarides lying outside the outer membrane of the gram - cells and outside the
peptidoglycan of gram + cells
protects bacteria from antibiotics- sticks to implants
what is a biofilm
colonies of bacteria that live attached to implant
Bacteria produce exopolysaccharide polymers
Assist the cells to firmly adhere to tissues or implant
Bacteria produce inside the glycocalyx and form colonies
how to remove biofilm
need to remove implant
bioflims protect bacteria from immune system and antibiotics
