Test 1: open fixation

Question 1

what is an open fracture

Answer 1

Fracture of the bone with exposure to the environment

All contaminated, but not all infected or will become
infected

Question 2

type 1 open fracture

Answer 2

small <1 cm wound

low energy trauma: simple fracture

minimal soft tissue damage

small amount of wound contamination

low infection and complication rate

Question 3

type II open fracture

Answer 3

> 1 cm

usually external trauma: outside to inside

mild to moderate soft tissue damage

simple or comminuted fracture

moderate contamination

Question 4

type III open fracture

Answer 4

extensive soft tissue damage with devitalization

major contamination

high energy trauma: gun shot

lots of pieces

outside to inside trauma

Question 5

Type IIIa open fracture

Answer 5

Adequate soft tissue coverage for fractured bone despite an extensive laceration or ST flaps

No major reconstructive procedures

Question 6

type IIIb open fracture

Answer 6

ST loss and inadequate ST coverage with periosteal
stripping and exposure of bone

Question 7

Type IIIc open fracture

Answer 7

Extensive ST damage with damage to the arterial blood supply

• Arterial blood supply must be repaired to salvage limb

Question 8

most open fractures become infected —

Answer 8

in the hospital (nosocomial)

need to cover open wounds with sterile dressing to prevent contamination and soft tissue damage

Question 9

goal of initial wound management

Answer 9

remove dead or dirty material

make clean wound with adequate blood supply

lavage, debridement, sterile bandage

Question 10

debridement rules

Answer 10

can remove most fat and fascia

but more conservative with muscle and skin

things like bone, ligaments and tendons should try to be preserved

wait and see approach- might need staged debridements

Question 11

when to give antibiotics for wounds

Answer 11

start ASAP, get culture first

give IV drugs for 72 hours

Question 12

type 1 open fractures should use what antibiotic

Answer 12

−Usually involve contamination with aerobic, gram positive bacteria

−1st generation cephalosporins
(Cefazolin/Cephalexin)

Question 13

type II and III open fractures should use — antibiotics

Answer 13

broad spectrum: gram + or gram -

Question 14

advantages of ex fix

Answer 14

gives easy access to wound
pins can be removed easily
decreases damage to soft tissue

Question 15

when to use bone grafting

Answer 15

type I and II
can use autogenous cancellous bone graft at same time as repair

type III
delayed grafting- 4-6 weeks post repair

Question 16

when to do bandage changes

Answer 16

more frequently for worse wounds

should use sterile technique

debridement and lavage as needed

Question 17

osteomyelitis

Answer 17

Inflammatory condition
affecting bone (periosteum, cortex, & medullary canal) usually due to an infectious cause such as bacterial, fungal, or occasionally viral

Question 18

what is post traumatic osteomyelitis

Answer 18

infection secondary to surgery

on implant

Question 19

how to cause osteomyelitis

Answer 19

ischemic event (trauma or surgery)

bacterial colonization:
-Hematogenous
-Direct inoculation*
-Contiguous infection

Question 20

what are some systemic factors that lead to infection

Answer 20

§ Hypovolemia
§ Malnutrition
§ Obesity
§ Endocrine diseases
§ Immunosuppression

Question 21

what are some local factors that lead to bone infection

Answer 21

Unstable fracture
Tissue metabolism
Foreign material
Dead space

Question 22

bacterial glycocalyx

Answer 22

Network of polysaccarides lying outside the outer membrane of the gram - cells and outside the
peptidoglycan of gram + cells

protects bacteria from antibiotics- sticks to implants

Question 23

what is a biofilm

Answer 23

colonies of bacteria that live attached to implant

Bacteria produce exopolysaccharide polymers

Assist the cells to firmly adhere to tissues or implant

Bacteria produce inside the glycocalyx and form colonies

Question 24

how to remove biofilm

Answer 24

need to remove implant

bioflims protect bacteria from immune system and antibiotics

Question 25

clinical signs of osteomyelitis

Answer 25

history of surgery, trauma or infection
swelling, drainage, pain

take culture and Xrays

Question 26

dead piece of bone

Answer 26

sequestrum

Question 27

zone of reactive tissue or bone surrounding sequestrum

Answer 27

involucrum

(radioleucent line)

Question 28

how to treat osteomyelitis

Answer 28

antibiotics can help but biofilm usually protect bacteria (1st gen cephalosporin, beta lactamase resistant penicillin and clindamycin)

need to remove implant and debride necrotic tissue or sequestrum

need to stabilize fracture

lavage and drainage

Question 29

how long to give antibiotics for osteomyelitis

Answer 29

at least 6-8 weeks

antibiotics picked based on culture

Question 30

prior to results of culture what antibiotics should you use for bone infection

Answer 30

Assume Staphylococcus sp. (β-
lactamases) or mixed (gram neg and anaerobic)

§ 1 st generation Cephalosporins
§ β-lactamase resistant Penicillins
§ Clindamycin

Question 31

antibiotic beads

Answer 31

give high local concentration of antibiotic to ischemic area