Open Fracture

Fracture (discontinuity in bone) that is in communication with an epithelial-lined surface

• Skin
• GIT

Gustilo-Anderson Classification

1. Type I: <1cm (inside-out mechanism) wound
2. Type II: <10cm; no soft tissue loss, no periosteal stripping
3. Type III >10cm or with contamination
   • IIIa: extensive soft tissue damage / gross contamination irrespective of wound size (farmyard, GSW)
   • IIIb: soft tissue loss resulting in inadequate amounts of tissue to cover the bone
   • IIIc: neurovascular injury that requires repair to maintain limb viability

Managment

1. ATLS principles
   • Airway
   • Breathing
   • Circulation
2. Assess limb
   • Assess neurological function of limb
   • Assess vascular status
   • Examine wound
   • Photograph wound prior to dressing it and attach photo to notes
3. Treatment
   • Cover wound with betadine-soaked dressing
   • Immobilise limb (in POP, gutter splint, cricket pad splint) +/- manipulation of fracture
   • Systemic antibiotics with broad-spectrum cover + tetanus prophylaxis
   • Adequate analgesia
   • Debride within 6-8 hours; should never be closed primarily; re-examine 48h after; close wound when clean with no evidence of necrotic tissue (primary suture, second intention or flaps)