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Flashcards in 42. Open fractures Deck (13):
1

open fracture classification (Gustilo Anderson)

I. < 1 cm wound created from inside, mild bruising, cleanII. > 1 cm wound created from outside, without extensive ST injuryIIIa. extensive ST damage with ST flaps but can still cover woundIIIb. extensive ST damage and loss with bone exposure and periosteal strippingIIIc. extensive ST damage, bone exposure and injury to vascular supply

2

T/Fearly administration of broad spectrum Ab is described by many to be the single most important factor for reducing infection in open fracture cases

Truesystemic Ab most often (other treatment option is implantation of Ab beads)

3

initial surgical debridement of open fractures

clip, clean, lavage, culture, cut, initial Ab, stabilizationprompt but 6 hours is a "golden rule" that is not necessarily demonstrated to have a significant difference in infection rates

4

goals of definitive surgical treatment of open fractures

1. prevent infection2. promote bone union3. repair ST injury4. restore function

5

benefits to vacuum assisted wound healing for management of ST injuries in open fractures

-125 mm Hg (continuous or intermittent)decreases edemapromotes vascularization/incr tissue blood flowaccelerates GT formationpromotes wound contraction+/- increases bacterial clearance

6

Options for surgical repair of extensive ST injury over a fracture

1. primary closure2. second intention3. pedicle muscle transfers4. microvascular free muscle transfers5. axial pattern skin flap6. microvascular free skin grafts7. mesh skin or punch skin grafts8. local skin/transposition flaps

7

internal fixation with bone plates can be used for most open fractures but is ideally best for what types of open fractures

I-III that do not involve extensive ST injury with the need for flaps, grafts

8

advantages of ESF for tx of open fractures

1. decreased application time2. location of implants away from wound3. easy access for open wound management4. minimal disruption to tissues5. expect implant removal

9

complications of ESF for tx of open fractures

1. pin loosening2. pin track drainage3. infection4. delayed union/malunion5. fixation failure

10

what is the theoretical risk for ILN system in management of open fractures

spread of bacteria to the entire medullary cavity

11

methods to improve fracture healing in open fractures

1. bone grafts (autogenous cancellous or corticocancellous, allogenic materials, demineralized bone matrix)2. bone graft substitutes3. recombinant mitogenic/stimulatory factors

12

T/Fa cortical bone graft is at risk for infection and subsequently becoming a sequestrum

TRUEa cortical bone graft is at risk for infection and subsequently becoming a sequestrumcancellous bone grafts can be used safely in a contaminated wound.

13

potential complications with open fracture

1. superficial infection2. deep infection3. delayed or malunion4. fixation failure5. necrosis of ST or damage to ST repair techniques6. temporary or permanent neurologic dysfunction

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