Traumatic fractures

Question 1

What is an open fracture?

Answer 1

Direct communication between the external environment and the fracture.

Usually through break in skin but may penetrate external orifice

Question 2

Why are open fractures important

What are the most common sites of electric fracture?

Answer 2

High energy injury
Increased infection rates
Soft tissue complications e.g. compartment syndrome
Long term morbidity

fingers and tibial shaft

Question 3

What is compartment syndrome

Answer 3

Increased pressure of an anatomical compartment leads to insufficient supply within th eompartment

Question 4

What are the gustila classifications of an open fracture?

Answer 4

Type1- <1cm, clean simple fracture
Type 2 >1cm, moderate soft tisue damage, simple fracture
Type 3A-extensive soft tissue damage, complex fracture, adequate periosteal cover
Type 3B- extensive soft tissue damage, complex fracture pattern, tissue loss requiring soft tissue
Type 3C- extensive soft tissue damage, complex fracture, vascular injury requiring repair

Question 5

What are the treatment guidelines for an open fracture

Answer 5

MDT- orthopaedic and plastic surgeons with appropriate experience
Treat immediate open fractures and arrange for immediate referral to a speciaist
Primary surgical treatment-wound debridement , excision and skeletal stabilisation

Question 6

What are the different levels of a fracture pattern?

Answer 6

Transverse or short oblique tibial fractures with fibular fractures at similar levels

Tibial fractures with communication/butterfly fragments with fibular fractures at a similar level

Segemental tibial fractures

Fractures with bone loss, either from extrusion at the time of injury or after debridment

Question 7

What are the different levels of soft tissue injury patterns

Answer 7

Skin loss such that free closure is not possible
Degloving- capillaries and skin ripped off
Injury to the muscles which require excision of devitalised muscle via wound extensions
Injury to one or more of the major arteries of the leg

Question 8

What is the immediate management of a severe open fracture?

Answer 8

ATLS assessment and treatment
Tetanus and antibiotic prophlaxis
Cefuroxim/augmentin/clindamycin
check neurovascular status
No provsional exploriation
Radiographs include joint above and below

Question 9

What are the time specific criteria for surgery

Answer 9

Wound, soft tissue and bound excision is carried out by a senior plastic and orthopaedic surgeons. Treat within 24 hours of the injury, unless there is a marine, agricultural or sewage contamination

Question 10

What are the four C’s to consider during surgical debridement and fixation

Answer 10

Colour

Contraction

Consistency

Capacity to bleed

Question 11

What are the crtieria for amputation

Answer 11

Dual consultant decision
Insensitive limb/foot
Irretrievable soft tissue/ bony damage
Other life threatening injuries