Symposium - Open Fracture

Question 1

What is an open fracture?

Answer 1

Open fracture = any fracture where direct communication between the external environment and break in skin

Question 2

What is an example of an open fracture but not through the skin?

Answer 2

Usually due to break in skin, but not always:

• Such as fragments of bone of fractured pelvis penetrating rectum

Question 3

Describe the epidmiology of open fracture?

(incidence, most common bones)

Answer 3

• Incidence 23/100,000
• Fingers and tibial shaft account for >50%

Question 4

What system is used to classify open fractures?

Answer 4

Gustilo classification of open fractures used:

Question 5

Describe the Gustilo classification system?

Answer 5

Question 6

What are the 4 different kinds of fracture patterns?

Answer 6

• Transverse
• Fractures with comminution/butterfly fragments (broken into many bits)
• Segmental tibial fractures
• Fractures with bone loss

Question 7

What are the 4 soft tissue injury patterns related to fractures?

Answer 7

• Skin loss
• Degloving
• Injury to muscles
• Injury to arteries of leg

Question 8

Describe the management for open fracture?

Answer 8

• MDT approach
  
  • Improved outcome for patients
• ATLS assessment and treatment
• Tetanus and antibiotic prophylaxis
  
  • Cefuroxime/augmenin/clindamycin
• Radiographs
• Emergency surgery
  
  • Within 6 hours
    
    • Indications – polytraumatised patient, marine or farmyard environment, gross contamination, neurovascular compromise, compartment syndrome
  • Debridement
    
    • Wound, soft tissue and bone excision
    • 4Cs – based on colour, contraction, consistency and capacity to bleed
  • Fixation
    
    • Temporary or definitive
  • Skin coverage
    
    • Options - split skin grafts (SSG), myofasciocutaenous, fasciocutaneous, rotation, free flap
  • Possible amputation
    
    • Use scoring system to decide if required, depends on – blood supply, sensation, age, shock, injury mechanism

Question 9

What are indications for emergency surgery within 6 hours for open fracture?

Answer 9

• Indications – polytraumatised patient, marine or farmyard environment, gross contamination, neurovascular compromise, compartment syndrome

Question 10

How is dead tissue identified during debridement?

Answer 10

• 4Cs – based on colour, contraction, consistency and capacity to bleed

Question 11

What is debridement?

Answer 11

• Wound, soft tissue and bone excision

Question 12

What are some options for skin coverage for open fracture treatment?

Answer 12

• Options - split skin grafts (SSG), myofasciocutaenous, fasciocutaneous, rotation, free flap

Question 13

How do you decide if amputation is required for open fracture?

Answer 13

• Use scoring system to decide if required, depends on – blood supply, sensation, age, shock, injury mechanism