Emergency Strategy - How to treat open fracture
Emergency Strategy - How to treat open fracture
The initial steps in treating open fracture is the assessment of the patient’s airway, breathing, circulation, disability and exposure. Patient is kept nil per os ( no oral intake), IV lines are established and consider tetanus vaccination if required. In case of loss of distal pulse consider longitudinal traction. Bleeding need to be controlled with compression. In case of uncontrollable bleeding/hemorrhage or traumatic amputation consider tourniquet. Remember to immobilize the joint above and below the fracture. The open wound is cover with moist, sterile dressing and infection is avoided by reducing the times the dressing need to be changed.
Infection can be avoided at early stages by administrating antibiotics . Gentle reduction of the fracture is considered. Consultation by vascular surgeon and orthopedic surgeon are important. Vascular surgeon will assess the vascular status of the patient while the orthopedic surgeon with perform irrigation, debridement ( perform within 6 hours may reduce the risk of infection) and fixative operation.Look and report for any evidence of compartment syndrome. Patient with open fracture is mostly admitted for IV antibiotics , debridement , irrigation and operative fixation. Patient will be discharged with oral antibiotics and follow up is required for 1- 2 days.
Patient with open fracture may also present with defective in neurovascular status, deformity and loss of the skin of continuity. 70% of patient with open fracture may present with traumatic injuries. Patient may reported the history of trauma. Complete orthopedic examination, vascular examination and neurological examination are performed. Conduct a thorough assessment at the site of fracture to reduce the risk of morbidity and to differentiate open fracture from simple abrasion and laceration.
The investigations require are full blood count, urea and electrolytes, coagulation studies, type and cross match of blood for potential loss of blood, culture pre and post debridement may be considered/rarely done.
Radiography studies is important and should include the joint above and below the sites of fracture. Angiography or doppler are useful in assessing for any evidence of vascular compromise, massive destruction/injury to the soft tissue area, ischemia of the extremities or dislocation of the posterior knee. If joint involvement is suspected consider arthrogram ( intra articular injection of methylene blue and saline).
What is open fracture? Open fracture is a loss of continuity of the skin at the site of fracture which can be from a small puncture wound to grossly contaminated bone exposure. Open fracture is also known as compound fracture. The bone has fractured and breached the skin which make it susceptible to infection. Open fracture are mostly associated with penetrating trauma or just plain blunt trauma. Open fracture may lead to instability of the fracture. Besides that patient who suffer from other co morbidity such as diabetes may suffer from the worst complication due to open fracture. Vascular system may be compromised and the wound will be contaminated and tissue damage or necrosis may occur. Because of this , emergency surgery is required to reduce the risk of complication.
References
1.Bhandari, M., G. H. Guyatt, M. F. Swiontkowski, and E. H. Schemitsch. “Treatment of Open Fractures of the Shaft of the Tibia A SYSTEMATIC OVERVIEW AND META-ANALYSIS.” Journal of Bone & Joint Surgery, British Volume 83-B, no. 1 (January 1, 2001): 62–68. doi:10.1302/0301-620X.83B1.10986.
2.DeLong, W G, Jr, C T Born, S Y Wei, M E Petrik, R Ponzio, and C W Schwab. “Aggressive Treatment of 119 Open Fracture Wounds.” The Journal of Trauma 46, no. 6 (June 1999): 1049–1054.
3.Patzakis, M J, and J Wilkins. “Factors Influencing Infection Rate in Open Fracture Wounds.” Clinical Orthopaedics and Related Research no. 243 (June 1989): 36–40.
The initial steps in treating open fracture is the assessment of the patient’s airway, breathing, circulation, disability and exposure. Patient is kept nil per os ( no oral intake), IV lines are established and consider tetanus vaccination if required. In case of loss of distal pulse consider longitudinal traction. Bleeding need to be controlled with compression. In case of uncontrollable bleeding/hemorrhage or traumatic amputation consider tourniquet. Remember to immobilize the joint above and below the fracture. The open wound is cover with moist, sterile dressing and infection is avoided by reducing the times the dressing need to be changed.
Infection can be avoided at early stages by administrating antibiotics . Gentle reduction of the fracture is considered. Consultation by vascular surgeon and orthopedic surgeon are important. Vascular surgeon will assess the vascular status of the patient while the orthopedic surgeon with perform irrigation, debridement ( perform within 6 hours may reduce the risk of infection) and fixative operation.Look and report for any evidence of compartment syndrome. Patient with open fracture is mostly admitted for IV antibiotics , debridement , irrigation and operative fixation. Patient will be discharged with oral antibiotics and follow up is required for 1- 2 days.
Patient with open fracture may also present with defective in neurovascular status, deformity and loss of the skin of continuity. 70% of patient with open fracture may present with traumatic injuries. Patient may reported the history of trauma. Complete orthopedic examination, vascular examination and neurological examination are performed. Conduct a thorough assessment at the site of fracture to reduce the risk of morbidity and to differentiate open fracture from simple abrasion and laceration.
The investigations require are full blood count, urea and electrolytes, coagulation studies, type and cross match of blood for potential loss of blood, culture pre and post debridement may be considered/rarely done.
Radiography studies is important and should include the joint above and below the sites of fracture. Angiography or doppler are useful in assessing for any evidence of vascular compromise, massive destruction/injury to the soft tissue area, ischemia of the extremities or dislocation of the posterior knee. If joint involvement is suspected consider arthrogram ( intra articular injection of methylene blue and saline).
What is open fracture? Open fracture is a loss of continuity of the skin at the site of fracture which can be from a small puncture wound to grossly contaminated bone exposure. Open fracture is also known as compound fracture. The bone has fractured and breached the skin which make it susceptible to infection. Open fracture are mostly associated with penetrating trauma or just plain blunt trauma. Open fracture may lead to instability of the fracture. Besides that patient who suffer from other co morbidity such as diabetes may suffer from the worst complication due to open fracture. Vascular system may be compromised and the wound will be contaminated and tissue damage or necrosis may occur. Because of this , emergency surgery is required to reduce the risk of complication.
References
1.Bhandari, M., G. H. Guyatt, M. F. Swiontkowski, and E. H. Schemitsch. “Treatment of Open Fractures of the Shaft of the Tibia A SYSTEMATIC OVERVIEW AND META-ANALYSIS.” Journal of Bone & Joint Surgery, British Volume 83-B, no. 1 (January 1, 2001): 62–68. doi:10.1302/0301-620X.83B1.10986.
2.DeLong, W G, Jr, C T Born, S Y Wei, M E Petrik, R Ponzio, and C W Schwab. “Aggressive Treatment of 119 Open Fracture Wounds.” The Journal of Trauma 46, no. 6 (June 1999): 1049–1054.
3.Patzakis, M J, and J Wilkins. “Factors Influencing Infection Rate in Open Fracture Wounds.” Clinical Orthopaedics and Related Research no. 243 (June 1989): 36–40.
