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Orthobullets Trauma > Open Fracture Management > Flashcards

Open Fracture Management Flashcards

(89 cards)

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1
Q

what are open fractures?

A

fractures with direct communication to the external environment

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2
Q

fractures with direct communication to the external environment

A

open fractures

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3
Q

most common location for open fractures

A

tibia and finger phalanx

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4
Q

associated conditions

A

additional injuries (30%)
compartment syndrome

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5
Q

percentage of open fractures associated with additional injuries

A

30%

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6
Q

the presence of an open wound does not preclude the occurrence of _____ in the injured limb

A

compartment syndrome

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7
Q

the size and nature of the external wound may not reflect the damage to the ____ structures

A

deeper

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8
Q

if concern for vascular insult, _____ should be obtained

A

ankle brachial index

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9
Q

normal ABI ratio

A

<0.9

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10
Q

vascular surgery consult and angiogram is warranted if ABI < ____

A

0.9

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11
Q

what do you do if ABI is <0.9

A

vascular consult and angiogram

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12
Q

consider ______ if concern for traumatic arthrotomy

A

saline load test or CT

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13
Q

consider saline load test or CT scan if concern for _____

A

traumatic arthrotomy

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14
Q

radiographs to obtain

A

obtain radiographs including joint above and below fracture

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15
Q

peri-articular injuries
evaluation for traumatic arthrotomy of the knee

A

CT

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16
Q

CT indications

A

peri-articular injuries
evaluation for traumatic arthrotomy of the knee

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17
Q

nonoperative treatment includes:

A

urgent IV antibiotics, tetanus prophylaxis, and extremity stabilization and dressing

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18
Q

nonoperative indications

A

initial treatment for all open fractures

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19
Q

a _____ should be treated as an open fracture until proven otherwise

A

soft tissue wound in proximity to a fracture

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20
Q

a soft tissue wound in proximity to a fracture should be treated as ____ until proven otherwise

A

an open fracture

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21
Q

operative management types

A

I&D, temporary fracture stabilization, local antibiotic administration and soft tissue coverage
definitive reconstruction and fracture fixation

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22
Q

consider ____ as soon as possible
ideal time of soft tissue coverage controversial, but most centers perform within 5-7 days

A

I&D

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23
Q

consider I&D as soon as possible
ideal time of soft tissue coverage controversial, but most centers perform within ____ days

A

5-7

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24
Q

infection rates of open fracture depend on _____, periosteal stripping and delay in treatment

A

zone of injury

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25
infection rates of open fracture depend on zone of injury, _____ and delay in treatment
periosteal stripping
26
infection rates of open fracture depend on zone of injury, periosteal stripping and _____
delay in treatment
27
incidence of fracture-related infection range from _____% in type I open fractures to 30% in type III fractures
<1
28
incidence of fracture-related infection range from <1% in type I open fractures to _____% in type III fractures
30
29
indications for definitive reconstruction and fracture fixation
once soft tissue coverage is obtained and an adequate sterility is achieved
30
definitive treatment with internal fixation leads to significantly decreased _____, improved functional outcomes, and decreased time in the hospital compared to those definitively fixed with external fixation
time to union
31
definitive treatment with internal fixation leads to significantly decreased time to union, improved ____ outcomes, and decreased time in the hospital compared to those definitively fixed with external fixation
functional
32
when should antibiotics be initiated
as soon as possible
33
studies show increased infection rate when antibiotics are delayed for more than ____ hours from time of injury
3
34
continue antibiotics for 24 hours after initial injury if wound is able to be _____
closed primarily
35
continue antibiotics for 24 hours after final closure if _____
wound is not closed during initial surgical debridement
36
antibiotics for Gustilo type 1 and 2
1st generation cephalosporin clindamycin or vancomycin can also be used if allergies exist
37
antibiotics for gustilo type 3
1st generation cephalosporin + aminoglycoside some institutions use vancomycin + cefepime
38
antibiotics for farm injuries, heavy contamination, or possible bowel contamination
add high dose penicillin for anaerobic coverage (clostridium)
39
add high dose penicillin for anaerobic coverage (clostridium)
farm injuries, heavy contamination, possible bowel contamination
40
antibiotics for fresh water wounds
fluoroquinolones or 3rd or 4th generation cephalosporin
41
antibiotics for salt water wounds
doxycycline + ceftazidime or a fluoroquinolone
42
when to initiate tetanus prophylaxis
in the ED or trauma bay
43
tetanus toxoid and immunoglobulin should be given intramuscularly with ____ different syringes in ____ different locations
two
44
guidelines for tetanus prophylaxis depend on 3 factors
complete or incomplete vaccination history (3 doses) date of most recent vaccination severity of wound
45
methods of stabilization
splint, brace, or traction for temporary stabilization decreases pain, minimizes soft tissue trauma, and prevents disruption of clots
46
remove gross debris from wound, do not remove any _____
bone fragments
47
place sterile _____ dressing on wound
saline soaked
48
recent meta-analysis (____ study) have recommended debridement within 24 hours to minimize risk of infection for type III fractures
goliath
49
recent meta-analysis (GOLIATH study) have recommended debridement within ____ hours to minimize risk of infection for type III fractures
24
50
recent meta-analysis (GOLIATH study) have recommended debridement within 24 hours to minimize risk of infection for type ____ fractures
3
51
recommended debridement within within ____ hours for type IIIB open tibia fractures
12
52
recommended debridement within within 12 hours for type ____ open tibia fractures
3B
53
taged debridement and irrigation perform every ____ hours as needed
24-48
54
I&D technique: extend wound ____ in line with extremity to adequately expose open fracture
proximally and distally
55
low-pressure bulb irrigation vs. high-pressure pulse lavage
no difference in infection or union rates
56
studies have shown that saline with ____ had decreased primary wound healing problems when compared to antibiotic solutions
Castile soap
57
how many liters of saline for Gustilo type 1?
3
58
how many liters of saline for gustilo type 2?
6
59
how many liters of saline for gustilo type 3?
9
60
thorough ____ of devitalized tissue is critical to prevent deep infection
debridement
61
bony fragments without ____ attachments should be removed
soft tissue
62
bony fragments without soft tissue attachments should be ____
removed
63
performed at the time of initial debridement
temporary fracture stabilization
64
____ is temporary initial treatment of choice for majority of high energy open fractures of the lower extremity
external fixation
65
significantly contaminated wounds with large soft tissue defects large bony defects
local antibiotics
66
indications for local antibiotics
significantly contaminated wounds with large soft tissue defects large bony defects
67
local antibiotics technique
beads made by mixing methylmethacrylate with heat-stable antibiotic powder vancomycin and tobramycin most commonly used
68
local antibiotics: beads made by mixing ____ with heat-stable antibiotic powder vancomycin and tobramycin most commonly used
methylmethacrylate
69
most commonly used antibiotic powder in local antibiotic treatment
vancomycin and tobramycin
70
timing of flap coverage for open tibial fractures remains controversial, < _____ days is desired
7
71
soft tissue coverage: odds of infection increase by ____% for each day beyond day 7
16
72
soft tissue coverage: odds of infection increase by 16% for each day beyond day ____
7
73
studies have not shown any statistical difference between rate of ___ when ORIF is performed before fasciotomy closure, at fasciotomy closure, or after fasciotomy closure
infection
74
can proceed with bone grafting after wound is ____
clean and closed
75
_____ wound therapy may be utilized during debridement until definitive coverage can be achieved
negative-pressure
76
Definitive reconstruction and fracture fixation if no critical bone defect:
open reduction and internal fixation or intramedullary treatment depending on fracture location and morphology
77
definitive reconstruction and fracture fixation if critical bone defect:
Masquelet technique ("induced-membrane" technique) distraction osteogenesis vascularized bone flap/transfer
78
Masquelet technique 1st stage
I&D, cement spacer and temporizing fixation
79
Masquelet technique 2nd stage
placement of bone graft into "induced membrane" and definitive fixation
80
Studies show optimal time frame for bone grafting to be _____ weeks after placement of cement spacer
4-6
81
complications of open wounds
surgical site infection osteomyelitis Neurovascular injury Compartment syndrome
82
osteomyelitis incidence ranges between ______% depending on the bone involved and fracture characteristics
1.8% to 27%
83
the most common site of post-surgical osteomyelitis following surgical treatment of open fractures
tibia
84
blast mechanism of injury acute surgical amputation delay in defintive soft tissue coverage greater than 7 days more severe Gustillo-Anderson classification.
osteomyelitis risk factors
85
osteomyelitis risk factors
blast mechanism of injury acute surgical amputation delay in defintive soft tissue coverage greater than 7 days more severe Gustillo-Anderson classification.
86
To minimize risk of infection, debridement recommended to be performed within ____ hours for all type III fractures and within 12 hours for type IIIB open tibia fractures
24
87
To minimize risk of infection, debridement recommended to be performed within 24 hours for all type III fractures and within ____ hours for type IIIB open tibia fractures
12
88
Infection rates higher in open injuries due to blunt or penetrating trauma?
blunt
89
____ rates higher in open injuries due to blunt trauma than penetrating trauma
infection

Orthobullets Trauma (63 decks)

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