OPEN FRACTURE MANAGEMENT

Question 1

INVOLVES 3 PHASE

Answer 1

EMERGENCY CARE
WOUND DEBRIDEMENT AND WOUND CARE
STABILISATION OF FRACTURE AND DEFINITIVE CARE

Question 2

EMERGENCY CARE

Answer 2

AT SITE OF ACCIDENT =
MAINTAIN ABC,
BLEEDING VESSEL PRESSED FIRMLY
WOUND CLEANED WITH RUNNING WATER
AT EMERGENCY DEPARTMENT =
MAINTAIN ABC
ALL OPEN FRACTURE ASSUMED TO BE CONTAMINATED
START ANTIBIOTICS AND TT
GOLDEN PERIOD - 6 HOURS

Question 3

ANTIBIOTICS

Answer 3

TYPE 1 - CEFAZOLIN 1 GM THREE TIMES A DAY FOR 3 DAYS
TYPE 2 - CEFAZOLIN 1 GM THREE TIMES A DAY FOR THREE DAYS
TYPE 3 - CEFAZOLIN 1 GM THREE TIMES A DAY + GENTAMICN 3 TO 5 MG

FOR ANAEROBES - CRYSTALLINE PENICILLIN

Question 4

WOUND DEBRIDEMENT AND WOUND CARE

Answer 4

@ EXCTP DEAD IC
WOUND EXCISION
WOUND EXTENSION
FRACTURE EXPOSURE
REMOVAL OF DEAD TISSUE
IRRIGATION -
TYPE 1 - 3L SALINE
TYPE 2 - 6 L SALINE
TYPE 3 - 9 L SALINE
HIGH VOLUME LOW PRESSURE
WOUND CLOSURE =
TYPE 1 - WOUND SUTURED
TYPE 2 - WOUND LEFT OPEN WITH LIGHT PACKING WITH STERILE GAUZE , SUTUTED WITHIN 2 DAYS .
TYPE 3 - REQUIRES PLASTIC SURGERY

Question 5

STABILISATION OF FRACTURE AND DEFINITIVE CARE

Answer 5

STABILISATION =
TYPE 1, 2, 3 A - EXT. FIXATION , IMIL, CAST
TYPE 3B - EXTERNAL FIXATION
TYPE 3 C - VASCULAR SURGERY IN ADDITION
DEFINITIVE CARE =
PLASTER
PINS AND PLASTER
SKELETAL TRACTION
EXTERNAL FIXATION
INTERNAL FIXATION

Question 6

OPEN FRACTURE SEQUELAE

Answer 6

INFECTION
CHRONIC OSTEOMYELITIS
ANKYLOSIS
CONTRACTURE OF SKIN