Download Free Medical Open Fractures PowerPoint Presentation

Open Fractures PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Open fractures management

Tags : health,fractures,bones,bones break,fractures management

Published on : Mar 23, 2022 | Views : 3962 | Downloads : 33

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Open Fractures Principles of Management Edwin Chege
Slide 2-

Historical fact … until WW I Treatment of open fractures was “Amputation” Mortality rate ~ 75% Function in “survivors” was poor Alois Karlbauer
Slide 3-

Objectives Definition of an open fracture Important points in history of an open fracture Classification Management: Initial treatment Importance of surgical debridement Bone treatment initial & definitive Soft tissue coverage Factors affecting outcome
Slide 4-

Definition Open fracture is a fracture where the skin coverage overlying is breached even a small puncture wound Another name: compound fracture www.merryshannon.com
Slide 5-

History in open fractures Mechanism of injury Date, time, type, method of impact, … Consciousness Size of wound Amount of bleeding Other injuries: often missed Anti-Tetanus status
Slide 6-

Type of injury Determines amount of energy and Extent of soft tissue injury
Slide 7-

Type of injury Fall: height is important Sport: stronger impact Heavy object falling: direct injury – soft tissue Road traffic accident (RTA): more severe Car (MVA) , motorcycle, pedestrian Assault & firearms: severe
Slide 8-

Mechanism of Injury Try to determine if injury was caused by: Low velocity High velocity Crushing under objects
Slide 9-

Mechanism of Injury Field of injury: Relatively clean Contaminated soil
Slide 10-

Mechanism of Injury Open injury from: In-out: usually cleaner Out-in: usually more contamination and dirt www.aofoundation.org
Slide 11-

Mechanism of Injury Penetrating Missiles Low velocity < 300 m/s - damage along the tract Comminution High velocity: >300m/s - sever comminution Comminution with wide soft tissue damage Some fragment inside Some flip inside Vacuum phenomena - cavitation
Slide 12-

Eye Witness
Slide 13-

Signs of high energy injury Segmental fracture Bone loss Compartment syndrome Crush syndrome Extensive de-gloving
Slide 14-

A. Karlbauer Examples Low energy High energy
Slide 15-

Approach – clinical exam General medical condition should be evaluated to exclude shock and brain injury Vital signs should be observed and followed up Look: special attention is to be paid to wounds
Slide 16-

Approach – clinical exam Feel: Sensory and motor deficits Pulse distal to injury Compartment syndrome Tense compartment Move: With care, if necessary! www.medicinabih.info
Slide 17-

Approach – clinical exam Examination of the viscera Rib fractures Lung, liver and spleen Pelvic fractures Urinary bladder and urethra Head and spinal injury Neurological examination
Slide 18-

Management of open fractures Initial management Classifying the injury Definitive treatment
Slide 19-

Initial management it is essential that the step-by-step approach in advanced trauma life support not be forgotten Treat the patient, not the fracture! (A B C)
Slide 20-

Initial management it is essential that the step-by-step approach in advanced trauma life support not be forgotten When the fracture is ready to be dealt with: The wound is carefully inspected Any gross contamination is removed The wound is photographed The area then covered with a saline-soaked dressing The patient is given antibiotics Tetanus prophylaxis is administered The limb circulation and distal neurological status checked repeatedly
Slide 21-

Grades of open fracture Important to grade severity of open injuries and soft tissue injuries To treat according to guidelines To have an idea about prognosis Several classifications Most widely used: Gustilo Classification
Slide 22-

Gustilo Classification Grade 1: Low-energy, minimal soft-tissue damage (wound < 1cm) Grade 2: Higher energy, no flaps needed / no crushing Moderate contamination (wound > 1cm) Grade 3: High-energy, flaps needed / crushing Significant contamination.
Slide 23-

Gustilo Classification Sub-Types of Grade III: Type 3A : Adequate soft-tissue cover Can cover skin primarily Type 3B: Inadequate cover Can not cover skin primarily May need skin graft or flap Type 3C: Vascular injury Requires vascular repair
Slide 24-

Gustilo Grade I Low energy Simple fracture Skin open by fragment pressure within – out Wound < 1 cm No / little contamination www.orthopaedicsone.com/
Slide 25-

Gustilo Grade II Higher energy Laceration > 1 cm No flap / No contusion Minimal contamination
Slide 26-

Gustilo Grade IIIA High-energy, Adequate soft-tissue cover Contamination Comminution or segmental fracture
Slide 27-

Gustilo Grade IIIB High-energy, Extensive soft-tissue stripping Inadequate cover, Massive contamination
Slide 28-

Gustilo Grade IIIA or IIIB An intra-operative decision
Slide 29-

Gustilo Grade IIIA or IIIB ? Adequate soft tissue coverage
Slide 30-

Gastilo Grade? IIIC
Slide 31-

Problem of open fractures Infection – skin is breached Primary: from the field Massive contamination Debris and foreign bodies Devitalized tissues Secondary infection after internal fixation Initial bacterial contamination Proper debridement not done Internal fixation is a foreign body
Slide 32-

Principles of treatment All open fractures, no matter how trivial they may seem, must be assumed to be contaminated The basic guidelines: Antibiotic prophylaxis Urgent and proper wound and fracture debridement Stabilization of the fracture – Early definitive wound cover
Slide 33-

Primary surgery The aims of primary surgery are: Preservation of life and limb Definitive injury assessment Staged wound debridement May need to repeat after 48-72 hours Fracture stabilization
Slide 34-

Primary surgery – Debridement Trim skin edges Remove foreign material Remove all dead muscles and lacerated tissues Remove fully detached small bone pieces Saline wash: 5 Liters (wash–wash–wash) ? Delayed secondary closure
Slide 35-

Primary surgery – Debridement www.us.elsevierhealth.com / Principles of Fracture Treatment
Slide 36-

Alois Karlbauer
Slide 37-

Alois Karlbauer
Slide 38-

Alois Karlbauer
Slide 39-

Alois Karlbauer
Slide 40-

ppt slide no 40 content not found
Slide 41-

ppt slide no 41 content not found
Slide 42-

Treatment guidelines Gustilo I and II: Can treat by primary internal fixation Rate of infection low – if follow guidelines Alois Karlbauer
Slide 43-

Treatment guidelines Gustilo IIIA Usually defer internal fixation until soft tissue condition allows Gustilo IIIB External fixation Later, internal fixation Gustilo IIIC Vascular repair is a priority External fixator
Slide 44-

Higher infection rate Increased contamination: Exposure to soil Exposure to water Exposure to fecal material Exposure to oral material Gross contamination Delay > 12 hours
Slide 45-

Role of Antibiotics About 60–70% of the open injuries are contaminated at the time of arrival to the emergency department and the organism may vary according to the ambience of injury. The antibiotic should have a broad spectrum of action and our first choice is either the first or second generation of cephalosporins. In open injuries involving proximal femur or pelvis or with associated abdominal or perineal injuries, it is prudent to add an aminoglycoside and metronidazole as there is an increased chance of fecal contamination