debridement of tibia

1. Duane Anderson, MD
Soddo Christian Hospital
Ethiopia
October 2017

2.  State the purpose of the
discussion
 Identify yourself
 Dr. Ramon Gustilo was
one of my mentors
 He had a weekly
conference for many
years on open fractures
 Father of the Orthopedic
Trauma Association OTA

3.  1- small less than one cm, usually puncture of a sharp
point of the fracture of the skin, implies low energy
injury
 2- larger laceration and more soft tissue injury,
moderate energy injury
 3a- high energy injury with severe bone and soft tissue
injury with coverage of the fracture possible without a
flap
 3b- high energy injury requiring a flap for fx coverage
 3c- with vascular injury

9.  Emergent care, excellent debridement is more
important than the timing of surgery
 Debridement
 Prophylactic Antibiotics
 Delayed Closure, cover fx in 5-7 days

10.  Don’t approximate wound of high energy
 Contaminated hematoma accumulates and bacterial
counts increase
 Free drainage of all contaminated fluids is more
important than wound approximation
 Leave wound closure concerns for another day
 I would rather do a flap and not have an infected
fracture

11.  Anatomy text in the OR! It’s a
must…, insist on your residents
knowing the anatomy before
cutting, review, review
 For femurs two structures you
have to avoid=femoral artery,
sciatic nerve
 Feel for the artery, find the nerve
if its in the area you are
debriding
 If you find these two structures
you will be more confident,
more aggressive, maybe your
patient won’t get infected