Open Fractures, Principles of Management

Question 1

Open fracture?

Answer 1

Direct communication between the external environment and fracture

->usually through skin but not always e.g. fragments of bone from a fractured pelvis penetrating the rectum

Question 2

Most common open fractures?

Answer 2

Tibial shaft
Fingers

Question 3

Open fractures can be described as distracting injuries- what does this mean?

Answer 3

Patient so focused on the open fracture that the lose control of airways, breathing or circulation

Question 4

Why is an open fracture from a farm or a marine environment more serious?

Answer 4

High risk of infection of aggressive microorganisms

Question 5

Management of open fractures?

Answer 5

Full ATLS assessment (ABCDE)
Tetanus vaccines and antibiotic prophylaxis
Broad-spectrum antibiotics
Repeated examination
Wounds only handled to remove gross contamination
Radiographs

Question 6

How quickly does a patient with an open fracture from a farm or marine environment have to go into surgery?

Answer 6

Within 6 hours to wash out the wound, debriding dead tissue and providing fixation

Question 7

What are the indications for emergency urgent surgery within 6 hours?

Answer 7

Polytraumatised patient
Marine or farmyard environment
Gross contamination
Neurovascular compromise
Compartment syndrome

Question 8

In the absence of criteria indicating surgery within six hours, how long before regular open fractures need to operated on?

Answer 8

Within 24hrs

Question 9

Debridement?

Answer 9

Removal of any dead tissue