Open Fractures

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5 Terms

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What is an open fracture?

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

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Classification of open fractures (Gustilo)

Type 1

  • wound <1cm, clean, simple fracture pattern

Type 2

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

Type 3

  • extensive soft-tissue damage, complex fracture patten

  • 3A - adequate periosteal coverage

  • 3B - tissue loss requiring soft-tissue coverage procedure (such as flap or graft)

  • 3C - vascular injury requiring repair

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Management of open fractures

advanced trauma life support and treatment (ATLS)

tetanus and antibiotic prophylaxis

cefruxime / augmentin / clindamycin

repeated examination n/v stats

wounds only handled to remove gross contamination

photograph, cover and stabilise limb

no provisional irrigation / exploration

radiographs

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Who should get emergency urgent surgery for an open fracture?

polytraumatised patient

marine or farmyard environment

gross contamination

neuromuscular compromise

compartment syndrome

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Definitive skin coverage methods

split thickness skin graft

myofasciocutaneous

fasciocutaneous

rotation

free flaps