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Ortho > Open Fractures + Osteomyelitis > Flashcards

Open Fractures + Osteomyelitis Flashcards

1
Q

Open fracture

A

Fracture of bone with exposure to environment

All contaminated, but not all will become infected

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2
Q

Open fracture classification based on

A

Mechanism of injury
Degree of soft tissue damage
Configuration of fracture
Degree of contamination

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3
Q

Type I open fracture

A

Small <1 cm wound
Inside to outside (bone penetrates skin + retracts)
Low energy traumatic impacts
Least contamination/lowest infection/complication rate

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4
Q

Type II open fracture

A

Wound >1cm
Usually external trauma (outside to in)
Mild to moderate soft tissue damage
Simple or comminuted
Moderate contamination

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5
Q

Type III open fracture

A

Extensive soft tissue damage
Major contamination
High energy trauma
Highly comminuted
Outside to in
3 subtypes

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6
Q

Type IIIa open fracture

A

Adequate soft tissue coverage despite extensive laceration of flaps

No major reconstructive procedures required

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7
Q

Type IIIb open fracture

A

Soft tissue loss or inadequate soft tissue coverage

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8
Q

Type IIIc open fracture

A

Extensive soft tissue damage including blood supply and/or nerves

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9
Q

Management of open fractures

A

Prevent infection
Soft tissue + bone healing
Restoration of anatomy
Functional recovery

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10
Q

Evaluation of patients with open fractures

A
  • Complete history/PE
  • May have multiple injuries
  • Life-threatening first
  • Assess neurovascular structures
  • Cover open wounds with sterile dressing (prevent nosocomial infection)
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11
Q

Wound management

A

Decrease contamination + improve blood supply

Lavage!!!!, debride, sterile bandage; ASEPTIC technique

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12
Q

Debridement

A

Fat/fascia - aggressive
Muscle/skin - conservative

If questionable - preserve + reevaluate

Bone/ligament/tendon - preserve unless absolutely necessary

**staged debridement

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13
Q

Antibiotic therapy for open wounds

A

Start immediately
Obtain culture + do sensitivity testing (culture from deep tissue)

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14
Q

General guidelines for Abx therapy of open wounds

A

Type I: usually aerobic, gram +; 1st gen cephalosporins

Type II, III: g + and -

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15
Q

Fracture repair

A

“New” surgery after debridment new instruments, gowns, gloves, etc

Construct healthy soft tissue envelop/reduction/alignment

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16
Q

Bone grafting

A

Type I/II - good soft tissue coverage; autogenous cancellous bone graft at time of repair

Type III - delayed grafting - 4-6 wk post-repair

17
Q

Wound closure

A

Delayed primary closure, local skin grafts, axial pattern flaps, free skin grafts

Second intention healing

Vacuum assisted closure

18
Q

Osteomyelitis

A

Inflammatory condition affecting bone (periosteum, cortex, medullary canal) usually due to infectious cause (bacterial, fungal - uncommon in NE, occasionally viral)

19
Q

Route of osteomyelitis

A

Hematogenous
Post-traumatic

20
Q

Pathogenesis of osteomyelitis

A

Ischemic event (fracture or surgery)

Concurrent bacterial colonization (hematogenous, direct inoculation, contiguous infection)

21
Q

Factors predisposing to osteomyelitis

A

Hypovolemia
Malnutrition
Obesity
Endocrine disease
Immunosuppressive
Unstable fracture
Tissue metabolism
Foreign material
Dead space

22
Q

Bacterial glycocalyx

A

Network of polysaccharides lying outside outer membrane of gram - cells and outside peptidoglycan of gram + cells (common in nature)

Exopolysaccharide polymers from bacteria - assist in adhesion to implant —> form biofilm

23
Q

Biofilms

A

Modify local environment to favor microbe + protect from immune system

Concentrate nutrients, prevent identification of surface antigens

Antibiotic resistance: impedes perfusion of agent, quiescent growth pattern, harsh microenvironment

24
Q

Chronic post-traumatic osteomyelitis

A

Most common form
Disease of ischemia
Weeks to yr after contamination

25
Q

Clinical signs of osteomyelitis

A

Draining tracts
Lameness
pain

26
Q

Radiographs of osteomyelitis

A

Bone lysis
Periosteal proliferation
Loose/broken implants
Non-viable bone fragments

27
Q

Sequestrum

A

Pieces of dead bone

28
Q

Involucrum

A

Zone of reactive tissue or bone surrounding sequestrum (radiolucent line on radiograph)

29
Q

Treatment of osteomyelitis

A

Antibiotics
Surgical debridement, lavage, drainage
Removal of implants (once fracture is healed)

30
Q

Antimicrobial treatment of osteomyelitis

A

Choose based on sensitivity results

Initially Parenteral —> oral

6-8 wks

31
Q

Delivery of Antimicrobial therapy

A

Local delivery
Antibiotic beads (non-biodegradable PMMA, biodegradable - plater of Paris) —> high local concentration, minimal systemic

Ortho (15 decks)

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