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    Open Fractures in Ortho Patients

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    Charisse Ann Gasataya
    This document discusses open fractures, which occur when a bone fracture communicates with the external environment through a break in the overlying skin. It presents the Gustillo-Anderson classification system for open fractures, which categorizes injuries based on wound size, soft tissue damage, contamination level, and fracture pattern. Type I are low energy injuries less than 1 cm while Type III injuries are high energy with extensive soft tissue damage. Later sections discuss debridement, immobilization, closure and infection risks associated with each classification.

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    Open Fractures in Ortho Patients

    Uploaded by

    Charisse Ann Gasataya
    14 views23 pages
    This document discusses open fractures, which occur when a bone fracture communicates with the external environment through a break in the overlying skin. It presents the Gustillo-Anderson classification system for open fractures, which categorizes injuries based on wound size, soft tissue damage, contamination level, and fracture pattern. Type I are low energy injuries less than 1 cm while Type III injuries are high energy with extensive soft tissue damage. Later sections discuss debridement, immobilization, closure and infection risks associated with each classification.

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    This document discusses open fractures, which occur when a bone fracture communicates with the external environment through a break in the overlying skin. It presents the Gustillo-Anderson classification system for open fractures, which categorizes injuries based on wound size, soft tissue damage, contamination level, and fracture pattern. Type I are low energy injuries less than 1 cm while Type III injuries are high energy with extensive soft tissue damage. Later sections discuss debridement, immobilization, closure and infection risks associated with each classification.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    14 views23 pages

    Open Fractures in Ortho Patients

    Uploaded by

    Charisse Ann Gasataya
    This document discusses open fractures, which occur when a bone fracture communicates with the external environment through a break in the overlying skin. It presents the Gustillo-Anderson classification system for open fractures, which categorizes injuries based on wound size, soft tissue damage, contamination level, and fracture pattern. Type I are low energy injuries less than 1 cm while Type III injuries are high energy with extensive soft tissue damage. Later sections discuss debridement, immobilization, closure and infection risks associated with each classification.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    OPEN FRACTURES

    BY: GASATAYA, CHARISSE ANN G.


    01 INTRODUCTION

    02 GUSTILLO – ANDERSON CLASSIFICATION

    03 LIMITATIONS AND DISADVANTAGES

    04 MANAGEMENT
    INTRODUCTION
    Open Fracture
     An injury where the fracture and the fracture hematoma
    communicate with the external environment through a
    traumatic defect in the surrounding tissue and overlying skin.
     Generally a result of high energy mechanisms which cause
    greater soft tissue disruption that leaves the wound more
    susceptible to infection by contaminating bacteria.
     The energy is stored in soft and hard tissues until the strength
    of respective material is exceeded. Comminuted pieces may
    acquire high velocity after which they propel into the
    surrounding soft tissues and cause additional damage.
    Compartment Syndrome

    Release of
    Trauma
    mediators of
    01 Contamination 02 inflammation
    03 “Leaky capillaries”

    Intravascular fluid Pressure buildup


    04 into the interstitial
    space
    05 compressing the
    microvasculature
    06 Cell death
    Prognosis
     Fracture pattern
     Local factors
     Amount of foreign debris and contaminant material
     Extent of soft tissue and bone devitalization.
     Systemic factors
     Host nutrition
     Medications
     Nicotine abuse
    GUSTILO – ANDERSON
    CLASSIFICATION
    Gustilo Classification

    01 Wound Size

    02 Soft Tissue Damage

    03 Contamination

    04 Fracture Pattern / Degree of


    Comminution
    I II IIIA IIIB IIIC
    Energy Low  Moderate High High High
    Wound Size ≤ 1 cm 1-10 cm  usually >10 cm usually >10 cm usually > 10 cm
    Soft Tissue
    Minimal Moderate  Extensive  Extensive  Extensive 
    Damage
    Clean Moderate
    Contamination  Extensive  Extensive  Extensive 
    contamination
    Severe Severe Severe
    Simple fx pattern
    Moderate comminution or comminution or comminution or
    Fracture Pattern with minimal
    comminution  segmental segmental segmental
    comminution
    fractures fractures  fractures 
    Periosteal
    No No Yes Yes Yes
    Stripping
    Requires free
    tissue flap or Typically requires
    Skin Coverage Local coverage Local coverage Local coverage
    rotational flap flap coverage
    coverage

    Exposed fracture
    Neurovascular with arterial
    Normal  Normal Normal  Normal
    Injury damage that
    requires repair
     Low energy
     < 1 cm long

    TYPE I  Minimal soft tissue damage


     Bone injury: minimal comminution
     Adequate soft tissue coverage
    OPEN FX  Clean
     Primary closure

    1st generation
    cephalosporin (e.g.
    cefazolin) for 24 hours after
    closure
     1 – 10 cm
     No extensive soft tissue damage, flaps or avulsions
    (moderate)
    TYPE II  Moderate contamination
     Adequate soft tissue coverage
     Primary closure
    OPEN FX  Bone injury: moderate comminution
     Soft tissue injury: moderate; some muscle damage

    1st generation
    cephalosporin (e.g.
    cefazolin) for 24 hours after
    closure
     Usually >10cm
     Soft tissue injury: severe with crushing
     Adequate soft tissue coverage Despite extensive
    TYPE IIIA soft tissue laceration
     Bone injury is usually comminuted; soft tissue
    coverage of bone is possible
    OPEN FX  Extensive contamination

    1st generation
    cephalosporin (gram +).
    Aminoglycoside (gram -)

    cephalosporin/aminoglycosi
    de should be continued for
    24-72 hours after the last
    debridement procedure

    Penicillin should be added if


    concern for anaerobic
    organism (farm injury)
     >10cm
     Extensive soft tissue injury loss, requires flap
    TYPE IIIB 

    Usually requires soft tissue reconstructive surgery
    Periosteal stripping and bone exposure
     Massive contamination
    OPEN FX

    1st generation
    cephalosporin (gram +).
    Aminoglycoside (gram -)

    cephalosporin/aminoglycosi
    de should be continued for
    24-72 hours after the last
    debridement procedure

    Penicillin should be added if


    concern for anaerobic
    organism (farm injury)
     Usually >10cm
     Soft tissue injury: Very severe loss of cover
     Arterial injury requiring repair
    TYPE IIIC  Bone cover is poor
     Usually requires soft tissue reconstructive surgery
    OPEN FX  High level of contamination

    1st generation
    cephalosporin (gram +).
    Aminoglycoside (gram -)

    cephalosporin/aminoglycosi
    de should be continued for
    24-72 hours after the last
    debridement procedure

    Penicillin should be added if


    concern for anaerobic
    organism (farm injury)
    Signs of Vascular Injury
    DISADVANTAGES
    Limitations & Disadvantages
     Interobserver reliability
     Overlapping categories
     Does not account for tissue viability and tissue necrosis
    over time
     Definition has undergone many modifications and does
    not have uniformity in application
     Includes wide spectrum of injuries in Type IIIB injuries
     Mainly depends on size of skin wound
     Does not evaluate severity of injury to skin, bone, and
    musculotendicous units separately
     Does not address the question of salvage
    MANAGEMENT
     DEBRIDEMENT
     All foreign materials and tissues that are contaminated or
    suspected to be avascular are systematically removed
     Should be done within 6 hours
     It minimizes the risk factors for infection
     Dead space
     Hematoma
     IMMOBILIZATION
     Skeletal stabilization
     Plaster casts
     Traction
     External skeletal fixation
     Primary internal fixation
     Plate fixation
     Intramedullary nails
     PRIMARY CLOSURE
    Grade 1 2 3A 3B 3C

    Infection 0-2% 2-7% 10-25% 10-50% 25-50%


    Rates

    Fracture
    Healing 21-28 28-30 30-35 30-35
    (weeks)

    Amputation 50%
    Rate
    - END -

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