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  • Open Fracture Classification and Management

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    nabiellarifin
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    This document provides information about open fractures, including their definition, classification, and management. It describes Gustilo's open fracture classification system which categorizes fractures into types I-III (with subclasses IIIA, IIIB, IIIC) based on energy level, wound size, soft tissue injury, contamination level, and other factors. The goals of fracture management are to recognize the fracture pattern, achieve reduction and alignment, maintain the reduction, and facilitate rehabilitation. Early complications can include neurovascular injury and compartment syndrome, while late complications may be delayed union, non-union, malunion, infection, or joint stiffness.

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    Open Fracture and It’s Classification and Management Siti

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    This document provides information about open fractures, including their definition, classification, and management. It describes Gustilo's open fracture classification system which categorizes fractures into types I-III (with subclasses IIIA, IIIB, IIIC) based on energy level, wound size, soft tissue injury, contamination level, and other factors. The goals of fracture management are to recognize the fracture pattern, achieve reduction and alignment, maintain the reduction, and facilitate rehabilitation. Early complications can include neurovascular injury and compartment syndrome, while late complications may be delayed union, non-union, malunion, infection, or joint stiffness.

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    © All Rights Reserved
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    197 vizualizări19 pagini

    Open Fracture Classification and Management

    Încărcat de

    nabiellarifin
    This document provides information about open fractures, including their definition, classification, and management. It describes Gustilo's open fracture classification system which categorizes fractures into types I-III (with subclasses IIIA, IIIB, IIIC) based on energy level, wound size, soft tissue injury, contamination level, and other factors. The goals of fracture management are to recognize the fracture pattern, achieve reduction and alignment, maintain the reduction, and facilitate rehabilitation. Early complications can include neurovascular injury and compartment syndrome, while late complications may be delayed union, non-union, malunion, infection, or joint stiffness.

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    din 19

    OPEN FRACTURE

    CLASSIFICATION AND MANAGEMENT


    SITI FATIMAH
    HOUSE OFFICER DEPARTMENT ORTHOPEDIC
    HOSPITAL KULIM KEDAH
    JUNE 2017
    DEFINITION
    A fracture with direct exposure to the external environment
    due to break in soft tissue cover.
    GUSTILO’S CLASSIFICATION

    • Gustilo and Anderson open fracture classification system


    is the most commonly used classification system for open
    fracture.
    • It was created by Ramón Gustilo and Anderson,
    • Then further expanded by Gustilo, Mendoza, and Williams.
    Gustilo Type I II IIIA IIIB IIIC

    Energy Low energy Moderate High High High

    Wound Size < 1 cm > 1cm >10cm >10cm >10cm

    Soft Tissue
    Minimal Moderate Extensive Extensive Extensive
    injury

    Moderate
    Contaminatio Clean
    contaminatio Extensive Extensive Extensive
    n
    n
    Simple # Severe Severe Severe
    Fracture pattern with Moderate comminution comminution comminution
    Pattern minimal comminution or segmental or segmental or segmental
    comminution fractures fractures fractures

    Periosteal
    No No Yes Yes Yes
    Stripping

    Requires free
    Local Typically
    Skin Local Local tissue flap or
    coverage requires flap
    Coverage coverage coverage rotational
    including coverage
    flap coverage

    Exposed
    fracture with
    Neurovascular arterial
    Normal Normal Normal Normal
    Injury damage that
    requires
    repair
    EXAMPLE OF DIAGNOSIS

    Open fracture 1/3


    proximal of the right
    femur grade 1
    HISTORY TAKING

    Chief complaint : pain at right thigh


    History of illness : suffered since 3 hour
    before admitted to the Hospital. There are
    no history of unconsciousness, severe
    headache, nausea and vomiting.
    Mechanism of trauma : Patient was riding
    motorcycle then crashed by a car from
    right side. The patient fall to the left side.
    PRIMARY SURVEY
    Airway : Patent
    Breathing : RR : : RR=20x/min, symmetrical, spontaneous,
    thoracoabdominal type
    Circulation : pulse : 80x/minute, regular, BP: 120/90mmHg
    Disability :GCS 15:E4M6V5(full)
    Exposure :Axillary temperature of 36.7oC
    SECONDARY SURVEY
    Right Femur region
    Inspection : Pin point wound at anterolateral femur, with
    size 0,5 x 0,5 cm, deformities (+), swelling (+)
    Palpation : tenderness (+)
    ROM : Active and passive movement of hip and knee joint
    are limited due to the pain
    NVD :Sensation intact, DPA PTA pulse palpable, Capillary
    refill time <2sec
    Leg length discrepancy
    LABORATORY FINDINGS

    HB :11.0
    PLT:229
    TWC : 9.0
    HCT:28
    UREA: 8.9
    NA:136.0
    K:4.5
    CREAT: 67
    RADIOLOGICAL FINDINGS
    Goals Of Fracture Management

    Recognize • Fracture site, types of fracture

    • For adequate apposition and


    Reduction normal alignment of bone

    Retain • Maintain the reduction

    Rehabilitation • Restore function

    Solomon. L. et al. Injury’s of the Knee and Leg in Apley’s System of Orthopaedics and Fractures 9th
    Edition. UK: Arnold. 2010.
    COMPLICATION
    EARLY COMPLICATION LATE COMPLICATION

    Neurovascular injury Delayed Union

    Non Union
    Compartment Syndrome
    Malunion

    Infection

    Joint Stiffness

    Solomon. L. et al. Apley’s System of Orthopedics and Fractures 9th Edition. New
    York : Arnold. 2010
    Thank you 

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