Open Fractures and Dislocations

Question 1

Open fracture definition

Answer 1

There is a direct communication between the external environment and the fracture

Question 2

Gustilo grading type I

Answer 2

• wound <1cm
• clean
• simple fracture pattern

Question 3

Gustilo grading type II

Answer 3

• wounds >1cm
• moderate soft tissue damage
• adequate skin coverage
• simple fracture pattern

Question 4

Gustilo grading type III

Answer 4

• extensive soft tissue damage
• complex fracture pattern

Question 5

Gustilo grading type III a

Answer 5

adequate periosteal coverage

Question 6

Gustilo grading type III b

Answer 6

tissue loss requiring soft tissue coverage procedure (such as a flap or graft)

Question 7

Gustilo grading type III c

Answer 7

vascular injury requiring repair

Question 8

Fracture patterns:

Answer 8

a. Transverse or short oblique tibial fractures with fibular fractures at a similar level
b. Tibial fractures with comminution/butterfly fragments with fibular fractures at a similar level
c. Segmental tibial fractures
d. fracture with bone loss, either from extrusion at the time of injury or after debridement

Question 9

Soft tissue injury patterns:

Answer 9

a. Skin loss such that tension free wound closure is not possible following wound excision
b. Degloving
c. Injury to muscle which requires excision of devitalised muscle via wound extensions
d. Injury to one or more major arteries of the leg

Question 10

Open fracture management

Answer 10

• full ATLS assessment and treatment
• tetanus and antibiotic prophylaxis

Question 11

Indications for emergency urgent surgery (6 hour rule?)

Answer 11

• Polytraumatised patient
• Marine or Farmyard environment
• Gross contamination
• Neurovascular compromise
• Compartment syndrome

Question 12

Amputation

Answer 12

• Dual consultant decision
• Insensate limb / foot
• Irretrievable soft tissue or bony damage
• Other life threatening injuries
• “Guillotine” type and refashion at a later stage

Question 13

Dislocation

Answer 13

Complete joint disruption

Question 14

Subluxation

Answer 14

partial dislocation - not fully out of joint

Question 15

Shoulder joint dislocation direction

Answer 15

• anterior
• posterior
• inferior

Question 16

Shoulder dislocation deformity

Answer 16

• squared off
• locked in internal rotation

Question 17

Elbow dislocation direction

Answer 17

posterior

Question 18

Elbow dislocation deformity

Answer 18

olecranon prominent posteriorly

Question 19

Hip dislocation direction

Answer 19

posterior

Question 20

Hip dislocation deformity

Answer 20

• leg short
• flexed
• internal rotation
• adduction

Question 21

Knee dislocation direction

Answer 21

• anterior
• posterior

Question 22

Knee dislocation deformity

Answer 22

• loss of normal contour
• extended

Question 23

Ankle dislocation direction

Answer 23

lateral more common

Question 24

Ankle dislocation deformity

Answer 24

• externally rotated
• prominent medial malleolus

Question 25

Subtalar dislocation direction

Answer 25

lateral more common

Question 26

Subtalar dislocation deformity

Answer 26

laterally displaced os calcis