Académique Documents
Professionnel Documents
Culture Documents
1. Definition
Fig. 61-4
Classification by Fracture Location
Fig. 61-6
Classification
• Closed (also called simple)
Fig. 61-5
Open Fractures
Type 1 Open Fractures
• Wound less than 1 cm,
• Inside-out injury
• Clean wound
• Minimal soft tissue damage
• No significant periosteal
stripping
http://www.unboundedmedicine.com/2005/11/08/open-fractures-classification-and-its-clinical-manifestations-3/
Type 2 Open Fractures
• Moderate soft tissue
damage
• Outside-in
• Higher energy
• Some necrotic muscle
• Some periosteal
stripping
Type 3a Open Fractures
• High energy
• Outside-in
• Extensive muscle
devitalization
• Bone coverage with
existing soft tissue
Type 3b Open Fractures
• High energy
• Outside in
• Extensive muscle
devitalization
• Requires a flap for
bone coverage
and soft tissue
closure
• Periosteal stripping
Type 3c Open Fractures
• High energy
• Increased risk of
amputation and
infection
• Any grade 3 with
major vascular injury
requiring repair
Why use this classification?
• Grades of soft tissue injury correlates with infection
and fracture healing
Grade 1 2 3A 3B 3C
Infection
0-2% 2-7% 10-25% 10-50% 25-50%
Rates
Fracture
Healing 21-28 28-28 30-35 30-35
(weeks)
Amputation
50%
Rate
Epidemiology
Open fractures
• 3% of all limb fractures
• 21.3 per 100,000 per year
Epidemiology
Clinical Manifestations
2. Physical Examination
General
Weight: shock
Other accompanying trauma
Local
Deformity udema, angulation, shorthening
Wound / No
Pain Press & Axis Pain
Acral / distal part: Artery, Veins, Nervus
3. supporting investigation
a. x-ray
Photo requirements on fracture: RULE OF TWO
- Two view (two way): AP & Lateral
- Two Joint :Two joints
- Two limb : Two side members
- Two Time : Two time intervals
Lee J. Efficacy of cultures in the management of open fractures. Clin Orthop Relat Res. 1997;339:71-5.
Initial assessment & management
• Sterile compressive dressings
• Realign fracture and splint
• Do not culture wound in the
ED*
– 8% of bugs grown caused deep
infection
– cultures were of no value and not
to be done
• Recheck pulse, motor and
sensation
Lee J. Efficacy of cultures in the management of open fractures. Clin Orthop Relat Res. 1997;339:71-5.
Primary surgery