Trauma symposium - open fractures Flashcards Preview

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Flashcards in Trauma symposium - open fractures Deck (15)
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1
Q

Define an open fracture

A

Any fracture where there is a direct communication between the external environment and the fracture

Pretty much always means when bone breaks thru skin - but not always (broken pelvis into rectum)

2
Q

What are the most common open fractures?

A

Tibial shaft

Fingers

^account for 50% of open fractures^

3
Q

How do we classify open fractures?

A

Gustilo classification system

Types 1, 2, 3a, 3b, 3c (worst)

4
Q

Give an overview of the Gustilo grades for fractures

A

Type I (simplest):

  • wound <1cm, clean, simple fracture pattern

Type II:

  • wound >1cm, moderate soft tissue damage, adequate skin coverage, simple fracture pattern

Type III:

  • Extensive soft tissue damage & complex fracture pattern
  • Subdivided further into 3a, b & c
5
Q

What is described by Gustilo type 3A, 3B & 3C?

A

Type 3 - Extensive soft tissue damage & complex fracture pattern with:

3A - adequate periosteal coverage (enough viable bone)

3B - not enough skin to cover fracture - ie needing plastics or skin graft

3C - vascular injury requiring repair

6
Q

What sort of injuries cause type 3 fractures?

What features of fractures are often seen in type 3s?

A

gunshot, farm accident, segmental fracture, bone loss, severe crush injury, marine

Fractures with Comminution & displacement often fall under type 3

7
Q

Describe the initial management of someone with a severe open fracture…

(ie management in casualty)

A

Full ATLS assessment & treatment

Tetanus & antibiotic prophylaxis

Repeated examination of neurovascular status

Remove any gross contamination

Photograph wound then cover & splint

Radiography - joint below & above etc

8
Q

What antibiotics are given for prophylaxis in a severe open fracture?

A

Cefuroxime, augmentin & clindamycin (or gentamicin)

9
Q

When is the only time that open fracture wounds should be handled in casualty?

What other fairly invasive thing is not done in casualty?

A

Handled only to remove any gross contamination

There is also no irrigation or exploration of the wound done at this stage

10
Q

What are the indications for urgent/immediate surgery for an open fracture?

A

Polytraumatised patient

Marine or farmyard environment (infection risk i presume)

Gross contamination

Neurovascular compromise

Compartment syndrome

If above not present then <24 hours is grand

11
Q

What is debridement?

What are the 4 C’s of debridement?

A

Surgical removal of any dead tissue (skin, bone & muscle)

What is the dead tissue? - determined using the 4 C’s…

  • Colour
  • Contraction (for muscle tissue)
  • Consistency
  • Capacity to bleed
12
Q

What is fixation?

A

Using plates & screws to either temporarly or permanently fix bone fragments etc together

Can be external (usually temporary) or internal (more permanent)

13
Q

What are the different options for skin covering?

A

SSG - split skin graft

Myofasciocutaneous - skin, fascia & muscle

Fasciocutaneous - skin & fascia

Rotation - no clue

Free flaps

14
Q

The last management option for the most severe open fractures is amputation…

What are the indications for amputations?

A

Decision made based largely on dual consultant decision and using scoring systems…

However - in general - indications for amputation include:

  • insensate limb/foot (irriversible neuro damage)
  • irretrievable soft tissue/bony damage
  • other life threatening injuries
15
Q
A