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Open fracture 5th year medical student tcd
- 1. 5th year Medical Students Trinity College Dublin
- 2. Objectives Understand definition of open fracture. Classification of open fracture Management of open fracture Complications of open fracture
- 3. Case 25 y/o male, involved in RTA. C/O Right leg pain and reduced ROM. BGHx: Nil significant NKDA o/e: leg is swollen, deformed with leg tenderness
- 4. How will you proceed to manage this patient? Why? A,B,C,D,E approach This is an isolated injury.
- 5. Describe X Ray. What else do you need? 2 views 2 joints
- 6. No pulse detected, management? Fracture reduced, pulse returned Further management?
- 7. Patient c/o severe preoperative pain despite IV paracetamol and oral Tramadol 50 mg. Further Rx?
- 8. Acute compartment syndrome of a limb is due to raised pressure within a closed fascial compartment Cardinal symptom for compartment syndrome: 5Ps ain ain ain ain ain
- 9. Pulses are normally present in compartment syndrome. Clinical examination: pain on passive movement of the muscles of the involved compartments
- 10. Management: All circumferential dressings released to skin and the limb elevated to heart level Document dose and rate of analgesia administered. Re-evaluated within 30 minutes If symptoms persist then urgent surgical decompression should be performed
- 11. What to do if in doubt?
- 12. Intra-compartment pressure > 30 OR ∆ P ( Diastolic BP- Intracompatment pressure)< 30
- 13. Wound washout was done in Theatre next day and wound debridement was done. Tissue coverage was done by plastic surgeon performing skin graft. Tibia fracture fixation was done by IM nailing.
- 15. Open fracture / Compound fracture Usually high energy injury A,B,C,D,E approach for management The vascular and neurological status of the limb is assessed systematically Vascular impairment requires immediate surgery within 3-4 hours Compartment syndrome also requires immediate surgery
- 20. Management Intravenous antibiotics are administered, ideally within 3 hours of injury Tetanus toxoid if booster dose less than 5 years Remove gross contamination and photography, then covered in saline soaked gauze and an impermeable film to prevent desiccation Orthoplastic approach for further management ( wound debridement and skletal stabilization)
- 21. Complications of open fracture: 1) Infection 4) Non union 3) Compartment syndrome 2) Neurovascular injury