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):
1

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

2

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

3

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

1. Fingers
2. Tibial Shaft

4

What are the Classifications of Open Fractures?

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

5

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

6

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

7

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

8

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

9

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

10

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

11

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

12

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

13

What is looked at for Surgical Debridement and Fixation?

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

14

Who takes responsibility for Skin Coverage?

Plastic Surgeons - "Rob Peter to pay Paul" Principle

15

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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