Morning Report: 7/31/2014

Today’s Morning Report is presented by Dr. Youn!

 

OPEN FRACTURES

 

  1. Definition: any fx that communicates with an overlying disruption of skin and soft tissues
  2. Initial assessment: still the ABCs (including pulses, hemorrhage control)
  3. Key history: mechanism, time course of event
  4. Physical exam: neurovascular status of injury, degree of contamination, associated injuries
  5. Emergent interventions (ortho consult): reduction, splinting, compartment pressures
  6. Analgesia, tetanus, irrigation, saline dressings
  7. Classification: Gustilo-Anderson Classification System: See below
  8. 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)
  9. Imaging
  10. 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
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital

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