Open Fx

Question 2

Covering the wound reduces infection from 12% to what %?

Answer 2

5%

Question 3

What % of infections are caused by organisms cultured at time of initial presentation?

Answer 3

18% (most are hospital acquired)

Question 4

Describe type 1, 2 and 3 on the Gustillo-Anderson Classification scheme for open fractures?

Answer 4

Type 1: Wound < 1cm (sharp fragments make wound, then often retract below level of skin)
Type 2: Wound >1cm without extensive soft tissue damage, flaps or avulsions (often wound was caused by outside forces)
Type 3: Extensive soft tissue damage (avulsion, degloving, bone loss) fractures with neurovascular injury, gunshots, traumatic partial amputations

There are 3 subtypes of Type 3:
IIIa: Adequate soft tissue available
IIIb: extensive loss of soft tissue, periosteal stripping, massive contamination
IIIc: arterial injury that will require repair (often we amputate in vet med)

Question 5

What % of traumatic appendicular fractures in dogs are open?
In cats?

Answer 5

Dogs 14%
Cats 29%

Question 6

In humans:
For type I and II fractures, what empiric antibiotic is advised?
For type III?

Answer 6

I and II: 1st or 2nd gen cephalosporin
III: cephalosporin + fluoroquinolone

Question 7

In a type III open fracture, pedicle and muscle flaps can be used if you can’t reconstruct the soft tissues locally. What % do they reduce nonunion to (from initially 30%)?

Answer 7

Reduced to 5% with early coverage - even in infected wounds.

Question 8

What are the complication rates for open fractures by type?
The nonunion rates?

Answer 8

Complications:
Type I 0-2%
Type II 2-10%
Type III 10-50%

Nonunions
Type I 0-5%
Type II 1-14%
Type III 2-37%