Morning Report: Open Fractures

OPEN FRACTURES

Definition: any fx that communicates with an overlying disruption of skin and soft tissues
Initial assessment: still the ABCs (including pulses, hemorrhage control)
Key history: mechanism, time course of event
Physical exam: neurovascular status of injury, degree of contamination, associated injuries
Emergent interventions (ortho consult): reduction, splinting, compartment pressures
Analgesia, tetanus, irrigation, saline dressings
Classification: Gustilo-Anderson Classification System: See below
Antibiotics
1. Class I/II – 1st generation cephalosporin (cefazolin)
2. Class II/III – 1st gen cephalosporin + aminoglycoside
3. Heavily contaminated wound (farming equipment, heavy soil): add penicillin or clindamycin or metronidazole for anaerobic coverage (clostridium)
Imaging
Operative Repair – Yes, please.

TYPE	I (0-2%)	II (2-5%)	IIIA	IIIB	IIIC
Wound Size	< 1cm	> 1cm	often large zone of injury	often large zone of injury	often large zone of injury
Soft Tissue	minimal	no extensive damage	extensive	extensive	extensive
Contam	clean	moderate	extensive	extensive	extensive
Fracture Pattern	simple, minimal comminution	moderate comminution	severe comminution or segmental fractures	severe comminution or segmental fractures	severe communition or segmental fractures
Skin Coverage	local coverage	local coverage	local coverage	replacement of exposed bone with free flap	local coverage
Neurovasc	normal	normal	normal	normal	arterial injury