Open fractures
Open Fracture
Fracture (discontinuity in bone) that is in communication with an epithelial-lined surface
- Skin
- GIT
Gustilo-Anderson Classification
- Type I: <1cm (inside-out mechanism) wound
- Type II: <10cm; no soft tissue loss, no periosteal stripping
- Type III >10cm or with contamination
- IIIa: extensive soft tissue damage / gross contamination irrespective of wound size (farmyard, GSW)
- IIIb: soft tissue loss resulting in inadequate amounts of tissue to cover the bone
- IIIc: neurovascular injury that requires repair to maintain limb viability
Managment
- ATLS principles
- Airway
- Breathing
- Circulation
- Assess limb
- Assess neurological function of limb
- Assess vascular status
- Examine wound
- Photograph wound prior to dressing it and attach photo to notes
- Treatment
- Cover wound with betadine-soaked dressing
- Immobilise limb (in POP, gutter splint, cricket pad splint) +/- manipulation of fracture
- Systemic antibiotics with broad-spectrum cover + tetanus prophylaxis
- Adequate analgesia
- Debride within 6-8 hours; should never be closed primarily; re-examine 48h after; close wound when clean with no evidence of necrotic tissue (primary suture, second intention or flaps)
