open fractures

Question 1

complications of fractures?

Answer 1

immediate:
-local= open fx, infection, compartment syndrome, neurovascular injury
-systemic: shock, sepsis, thromboembolic events, fat emboli

late: osteomyelitis, mal/non-union, post-trauma arthritis, avascular necrosis

Question 2

classification of open fx by gustilo-anderson?

Answer 2

grade 1: size <1cm, minimal soft tissue injury and contamination, give 1st generation cephalosporin (cephazolin) for 3 days

grade 2: size between 1 and 10cm, moderate soft tissue injury, give cephazolin for 3 days

grade 3A: size >10cm, extensive soft tissue injury but not needing skin graft
grade 3B: size >10cm, extensive injury that requires graft
grade 3C: size >10cm extensive injury with injury to MAJOR vessels not subcutaneous.

all grade 3 you give cephazolin and gentamicin (cover gram -ve). ABs to protect against osteomyelitis from S. Aureus

Question 3

what are the exceptions to gustilo anderson classification?

Answer 3

shot gun injury, soil/farm/water contamination, comminuted fx, fx injury >8hrs ALL CLASSIFIED GRADE 3 REGARDLESS OF SIZE

contamination with soil and farm needs penicillin as well.

Question 4

how to manage open fractures?

Answer 4

-if hemodynamically unstable, resuscitate following trauma protocol ABCDE

-give IV antibiotics (cephazolin/ gentamicin/ penicillin) and consider tetanus booster. give analgesics

-debridement and saline irrigation
-external fixation (internal once wound heals)

Question 5

open reduction vs closed reduction?
internal vs external fixation?

Answer 5

open reduction: direct manipulation of bones in surgery
closed reduction: realign through traction/splint /cast

external fixation: through pins and clamps and rods
internal fixation: in surgery use screws, k wires, intramedullary nails

Question 6

indications for ORIF?

Answer 6

-non union, polytrauma, neurovascular injury, open fx, salter harris 3-4-5, displaced intra articular fx

Question 7

indications for external fixation?

Answer 7

-severe open fx (3b), infected non union, initial management in polytrauma, contaminated fx, pelvic fx

Question 8

ORIF contraindication?

Answer 8

active infection, severe comminution, severe osteoporosis, severe soft tissue injury, non displaced fx