10.1. Fractures - Open Fractures Flashcards Preview

3rd Year - MSK Diseases > 10.1. Fractures - Open Fractures > Flashcards

Flashcards in 10.1. Fractures - Open Fractures Deck (15):

What is the definition of an "Open Fracture"?

There is a direct communication between the External Environment and the Fracture
Usually through a break in the skin but not always


What is the significance of an Open Fracture?

1. Higher Energy Injury
2. Increased Risk of Infection
3. Soft-Tissue Complications
4. Long-Term Moridity
Note - 1/3 of Polytraumatised patients have open fractures


What are the most common bones for Open Fractures to occur in?

1. Fingers
2. Tibial Shaft


What are the Classifications of Open Fractures?

1. Type 1 - Open Fractures
2. Type 2 - Open Fractures
3. Type 3 - Open Fractures


What are the Features of a Type 1 Open Fracture?

1. Low-Energy
2. Wound < 1 cm
3. Clean
4. Simple Fracture Pattern - Bone piercing skin from inside


What are the Features of a Type 2 Open Fracture?

1. Moderate Soft-Tissue Damage
2. Wound < 10cm
3. No Soft-Tissue Flap / Avulsion
4. Adequate Skin Coverage
5. Simple Fracture Pattern


What are the Features of a Type 3 Open Fracture?

1. High Energy
2. Extensive Soft-Tissue Damage
3. Severe Fracture (Communication Displacement)
4. Wound > 10cm


What are the different Subtypes of a Type 3 Open Fracture?

3A - Soft Tissue Damage +++, but not grossly contaminated
3B - Periosteal Stripping, Extensive Muscle Damage, Heavy Contamination
3C - Associated Neurovascular Complication


What are the different Fracture Patterns, in a Tibial Fracture?

A) Transverse / Short Oblique Tibial Fractures with Fibular Fractures at a Similar Level
B) Tibial Fractures with Communication / Butterfly Fragments with Fibular Fractures at a Similar Level
C) Segmental Tibial Fractures
D) Fractures with Bone Loss


What are the Soft-Tissue Injury Patterns, in a Tibial Fracture?

A) Skin Loss such tat Direct Tension-Free Closure is not possible following Excision
B) Degloving
C) Injury to the Muscles which requires Excision of Devitalized Muscle via Wound Extensions
D) Injury to 1+ of the Major Arteries of the Leg


What is the immediate Management of a Complex Open Fracture?

1. Full Advanced Trauma Life Support (ATLS) Assessment and Treatmen
2. Tetanus and Antibiotic Prophylaxis - Cefuroxime / Augmentin / Gentamycin
3. Repeated Neurovascular Status Examinatuon
4. Wounds only handled to remove Gross Contamination
5. No provisional Irrigation / Exploration


What are the indications for Emergency Surgery?

1. Polytraumatised Patients
2. Marine / Farmyard Environment
3. Gross Contamination
4. Neurovascular Compromise
5. Compartment Syndrome
Note - 6 hour rule


What is looked at for Surgical Debridement and Fixation?

4 C's:
1. Colour
2. Contraction
3. Consistency
4. Capacity to Bleed


Who takes responsibility for Skin Coverage?

Plastic Surgeons - "Rob Peter to pay Paul" Principle


When is Amputation considered?

1. Dual Consultant Decision
2. Insensate Limb / Foot
3. Irretrievable Soft Tissue / Bony damage
4. Other Life-Threatening Injuries

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