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?
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?
2. Wound < 1 cm
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
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. Capacity to Bleed
Who takes responsibility for Skin Coverage?
Plastic Surgeons - "Rob Peter to pay Paul" Principle