PHTH1110 008 Open Fractures - Wright.pdf

OPEN FRACTURTES Dr Dean Everett WRIGHT DEFINITION DEFN ➤fractured bone and/or fracture hematoma are exposed to the external environment via a traumatic violation of the soft tissue and skin. The skin wound may lie at a site distant to the fracture and not directly over it. MECH ➤ DIRECT HI ENERGY IN...

OPEN FRACTURTES Dr Dean Everett WRIGHT DEFINITION DEFN ➤fractured bone and/or fracture hematoma are exposed to the external environment via a traumatic violation of the soft tissue and skin. The skin wound may lie at a site distant to the fracture and not directly over it. MECH ➤ DIRECT HI ENERGY INJURY MVA/ FFH / VIOLENCE ➤ INDIRECT HI ENERGY TORSION EPID ➤ DIAPHYDSIS > METAPHYSIS ➤ TIBIA (25%) > FEMUR > FOREARM > ARM COMPONENTS ➤ FRACTURE ➤ SOFT TISSUE ➤ NEUROVASCULAR ➤ CONTAMINATION PATHOLOGY ➤ POOR TIISUE OXYGEN ➤ DEVITALIZED TISSUES ➤ > 2 weeks BACTERIAL MEDIUM NOSOCOMIAL ORGANISMS GNB/ PSEUD CLASSIFICATION 4 MESS SCORE ➤(MESS) is a scoring system that can be applied to mangled extremities and help one determine which mangled limbs will eventually come to amputation COMPLICATIONS Table 1 COMPLICATIONS Hypovolemic shock Compartment syndrome Fat embolism ARDS Neurovascula Infection 11 r injuries HYPOVOLEMIC SHOCK ➤emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body Table 1 Hypovolemic shock - management Two large- bore IV lines should be started. Once IV ac cess is obtained, ini tia l fluid re... COMPARTMENT SYNDROME Table 1 Compartment syndrome Classicall y 5 "Ps" compartment syndrome: 1) Pain out associated with — of propor tion to wha t is expe... TREATMENBT ➤ FASCIOTOMY FAT EMBOLISM VASCULAR INJURY MANAGEMENT