open fractures

Question 1

What is an open fracture

Answer 1

Fracture where there is a direct communication between the fracture and the external environment

Question 2

Which bones are most commonly involved in open fractures

Answer 2

Fingers and tibial shaft

Question 3

Describe the gustilo classification

Answer 3

As you go from type 1-3 - the open fracture becomes more severe

Question 4

What is the management of open fractures

Answer 4

ATLS assessment - ABCDE

Tetanus and antibiotic prophylaxis

Debridement

Cover wound with saline swabs

Surgical emergency surgery for open fractures - usually within 24 hours unless there are specific complications

Question 5

What is the antibiotic prophylaxis given for open fractures

Answer 5

Cefuroximen
Augmentin
Clindamycin

Question 6

What are the conditions that indicate emergency within <6 hours surgery (6 hour rule) for open fractures

Answer 6

Polytraumatised patient
Marine or farmyard environment
gross contamination
Neurovascular compromise
Compartment syndrome

Question 7

What is debridement

Answer 7

removal of dead tissue

Question 8

What is the criteria to differentiate dead tissue

Answer 8

4 C’s

Colour

Contraction - if muscle

Consistency

Capacity to bleed

Question 9

What conditions lead to the decision of amputation

Answer 9

Loss of sensation in the limb

irretrievable soft tissue or bone damage

other life threatening injuries