Open Fractures Flashcards
What is an Open #?
Direct communication between # site + external environment
What are the complications of Open #s? (3 things)
- Skin / soft tissue damage
- Neurovasc injury
- Infection
What is the the range of Skin damage in Open #s?
From small wounds to significant tissue loss
What does Skin damage in Open #s require?
Plastic surgery (skin grafting / local flap) for coverage
What is the the range of Soft tissue damage in Open #s?
From little tissue devitalisation to significant muscle / tendon / ligament loss
What does Soft tissue damage in Open #s require?
Reconstructive surgery
What is Neurovasc injury caused by in Open #s?
Limb deformity
What type of Neurovasc injury can limb deformities in Open #s cause? (2 things)
- Arteriospasm
2. Aortic dissection / transection (complete tear thru all layers of artery)
Why is there an increased risk of Infection in Open #s? (4 things)
- Direct contamination
- Reduced vascularisation
- Systemic compromise
- Need for metalwork insertion for # stabilisation
What are the clinical features of Open #s? (4 things)
- Pain
- Swelling
- Deformity
- Bone end visible sometimes
What should be checked in clinical examination of Open #s? (3 things)
- Neurovasc status
- Skin / tissue loss
- Contamination
What investigations should be done for Open #s? (3 things)
- Plain film XR
- CT (for very comminuted / complex #s)
- Routine bloods + coag screen + G&S
How do you manage an Open #? (4 things)
- Clean + Dress wound
- IV abx prophylactically (broad spec)
- Urgent realignment + splinting (within 72 hrs)
- Vasc surgery if vasc compromise
How should a Open # wound be cleaned? (2 things)
- Debridement (removing debris)
2. Wash w saline
