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This document summarizes the presentation of an open fracture case. It includes details of the patient's history, injury mechanism, examination findings, classification of the open fracture, management, and postoperative care. The conference discusses open fractures, highlighting the Gustilo classification system which grades open fractures based on wound size, soft tissue damage, and level of contamination. Higher grades have greater risks of complications like infection if not properly managed with urgent debridement, stabilization, and antibiotic prophylaxis.
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Protocols of wound debridement
This document discusses protocols for wound debridement. It defines debridement as removing dead, contaminated, or adherent tissue from a wound to facilitate healing. The main types of debridement covered are mechanical, enzymatic, sharp, autolytic, and biologic. Characteristics of necrotic tissue like color, consistency, and adherence are reviewed. Protocols for sharp debridement emphasize preparing the patient, thoroughly removing necrotic tissue from the wound base outward until bleeding edges are seen, and irrigating and dressing the wound. The goal of debridement is to remove barriers to healing and reduce the bacterial burden.
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Role of Wound Debridement
The document provides information on different types of wound debridement. It defines debridement as the removal of foreign material and devitalized or contaminated tissue from a wounded area. Various debridement methods are described, including sharp, mechanical, enzymatic, and larval therapies. Factors to consider when selecting a debridement method are outlined in an algorithm, such as time required, patient pain tolerance, environment, and caregiver skill level. The overall conclusion is that debridement should be performed when needed according to the algorithm guidelines and contraindications.
Tibial plateau fractures
This document summarizes tibial plateau fractures, including:
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- Treatment goals of restoring articular congruity, alignment, and stability
- Surgical techniques including plating and minimally invasive approaches
- Indications for surgery including articular displacement over 10mm or instability
Finger tip injuries
Finger tip injuries are common, especially in working adults and children, and require prompt treatment to restore function, sensibility, and a viable length. Injuries are classified based on the structures involved and treatments include revision amputation, primary closure, skin grafting, or flap reconstruction depending on the severity and location of the injury. Various flap techniques like V-Y advancement flaps or cross finger flaps are used to reconstruct the pulp and cover bone depending on the zone and site of injury on the finger or thumb.
Replantation of the hand and Upper extremity
1. Replantation involves reattaching a completely amputated body part to restore blood flow, while revascularization reattaches incompletely amputated parts.
2. Factors that determine replantation success include patient health, injury details, and surgical team skill.
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Protocols of wound debridement
This document discusses protocols for wound debridement. It defines debridement as removing dead, contaminated, or adherent tissue from a wound to facilitate healing. The main types of debridement covered are mechanical, enzymatic, sharp, autolytic, and biologic. Characteristics of necrotic tissue like color, consistency, and adherence are reviewed. Protocols for sharp debridement emphasize preparing the patient, thoroughly removing necrotic tissue from the wound base outward until bleeding edges are seen, and irrigating and dressing the wound. The goal of debridement is to remove barriers to healing and reduce the bacterial burden.
UPASICON 2015 SGPGI Lucknow Best Paper Presentation
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The document provides information on different types of wound debridement. It defines debridement as the removal of foreign material and devitalized or contaminated tissue from a wounded area. Various debridement methods are described, including sharp, mechanical, enzymatic, and larval therapies. Factors to consider when selecting a debridement method are outlined in an algorithm, such as time required, patient pain tolerance, environment, and caregiver skill level. The overall conclusion is that debridement should be performed when needed according to the algorithm guidelines and contraindications.
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- Classification systems including Schatzker and AO/OTA
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- Treatment goals of restoring articular congruity, alignment, and stability
- Surgical techniques including plating and minimally invasive approaches
- Indications for surgery including articular displacement over 10mm or instability
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Finger tip injuries are common, especially in working adults and children, and require prompt treatment to restore function, sensibility, and a viable length. Injuries are classified based on the structures involved and treatments include revision amputation, primary closure, skin grafting, or flap reconstruction depending on the severity and location of the injury. Various flap techniques like V-Y advancement flaps or cross finger flaps are used to reconstruct the pulp and cover bone depending on the zone and site of injury on the finger or thumb.
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1. Replantation involves reattaching a completely amputated body part to restore blood flow, while revascularization reattaches incompletely amputated parts.
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Fwd: Wound Healing
---------- Forwarded message ----------
From: UCD Graduate '09 None <ucdgrad09@gmail.com>
Date: 2009/2/20
Subject: Wound Healing
To: ucdgrad09@gmail.com
Management of hand injuries &
This document discusses the management of hand injuries and associated infections. Some key points:
- Hand injuries are common, usually affecting young males, and are often caused by domestic or work-related accidents. Proper treatment is important to prevent stiffness.
- Evaluation of hand injuries involves assessing wound characteristics, neurovascular status, and underlying bone or tendon injuries. Management principles aim to preserve the hand and restore function.
- Treatment depends on wound type but typically involves debridement, irrigation, splinting, antibiotics, and reconstruction of tendons, nerves or bone as needed. Complications can include infection, stiffness if not managed properly.
- Specific injuries like bites, foreign bodies, fingertip injuries
Tendon injuries of hand by Dr Saumya Agarwal
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The document discusses tendon injuries of the hand, including the anatomy, morphology, nutrition, and zones of injury of both flexor and extensor tendons. It covers the etiology, signs and symptoms, examination, detection, and treatment including surgical repair and postoperative rehabilitation of tendon injuries. The key aspects are meticulous surgical technique, appropriate postoperative mobilization, and supervision through rehabilitation to minimize complications of tendon injuries.Open Fracture.pptx
This document discusses open fractures and mangled extremities. It covers the goals of treatment which are to preserve life, limb and function while preventing infection and restoring stability and soft tissue coverage. Open fractures require urgent assessment and debridement to remove non-viable tissue which can be aided by lavage and the use of tourniquets. Skeletal stabilization is also important. Scores can help determine if limb salvage is possible or if amputation is required based on the extent of soft tissue and bone damage. Proper antibiotic use, wound coverage and further reconstruction are also outlined.
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Open fractures
Type 1 open fractures have a small wound less than 1cm with minimal soft tissue damage. Type 2 fractures have a wound over 1cm with moderate soft tissue damage. Type 3 fractures are high energy injuries with severe soft tissue damage and bone comminution. The classification correlates with infection risk, healing time, and need for flap coverage. For open fractures, the goals of treatment are to preserve life and limb through debridement, antibiotics, fracture stabilization, and early wound coverage.
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Dr.senthil sailesh- Wound debridement,open fracture,evidence based,
This document discusses wound debridement for open fractures. It recommends:
1) Starting IV antibiotics within 1 hour, such as cefazolin, and continuing for 3-5 days to reduce infection rates.
2) Performing urgent debridement within 6 hours to remove all necrotic tissue from the skin, subcutaneous tissue, fascia, muscle and bone.
3) Irrigating the wound with saline using gravity flow, with a minimum of 3 liters for type 1 fractures up to 9 liters for type 3 fractures. Antiseptics are not recommended.
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- Tests to evaluate ACL injuries like the Lachman and anterior drawer tests. MRI is recommended if initial tests are positive.
- Surgical timing - it's best to wait 1-3 weeks after injury for swelling to subside before operating to improve visualization.
- Surgical techniques for ACL reconstruction including fixation methods like interference screws and suspensory fixation devices.
- Associated injuries like PCL and MCL tears that may require staged procedures.
- Anatomical considerations like femoral footprints and the double bundle technique to reconstruct both bundles.
Wound management & dressings
wound management, dressings type, dirty and clean wounds, presents plan to manage different types of wounds and options of available dressings.
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skin incisions
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Open fracture
Extern orthopedics conference at Maharaj Nakornrachasima hospital by Ext.Torpathom Pruekprasert 29 May 2017
Extern conference-open fracture
This document describes the case of a 59-year-old Thai man who presented to the emergency department with an open fracture of the big toe on his left foot. He reported being injured when a water tank fell on his foot 4 hours prior. On examination, he had a 0.5 x 7 cm laceration wound exposing the bone of his big toe with limited range of motion due to pain. He was diagnosed with an open Gustilo type 2 fracture of the proximal and distal phalanx of the left big toe. His treatment included wound debridement, antibiotics, dressing, and tetanus booster.
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Mutilating injuries of the upper extremity often require complex reconstruction involving soft tissue, nerve, vascular, and bone procedures. A multidisciplinary approach is needed, beginning with thorough debridement and stabilization, followed by vascular reconstruction, tendon and nerve repair, and soft tissue coverage. Replantation or revascularization may be considered for amputated parts, depending on the severity of injury, ischemia time, and likelihood of functional recovery. Close postoperative monitoring and therapy are important to optimize outcomes from these challenging injuries.
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This document provides an overview of various amputation levels of the foot and ankle, including:
- Distal, great toe, lesser toe, and ray amputations to remove individual toes or parts of the foot.
- Transmetatarsal, Chopart's, and Syme's amputations, which remove increasing portions of the foot and ankle.
- Considerations for each procedure like bone removal, tendon management, wound closure, and prosthetics.
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The document discusses fractures, including their definition, causes, types, healing processes, and complications. It provides details on the principle management of fractures, including reduction, immobilization, and internal or external fixation. Key complications discussed are shock, diffuse coagulopathy, respiratory dysfunction, crush syndrome, deep vein thrombosis, fat embolism, gas gangrene, and tetanus.
Chronic Osteomyelitis
A 46-year-old female presented with pain, swelling, and fever in her left thigh for one week. On examination, she had a circumferential swelling on the upper third of her left thigh with tense, shiny edema. X-rays showed loss of fat and muscle planes, periosteal reaction thickening the bone, medullary rarefaction, and cortical discontinuity consistent with chronic osteomyelitis of the left femur. Treatment involved surgical debridement of infected bone along with long-term antibiotics to eliminate the infection.
Knee arthrocentesis
Arthrocentesis: A bedside procedure in which a sterile needle and syringe are used to drain fluid from the joint, and in some conditions, medication is injected into the joint after fluid removal.
Fwd: Wound Healing
---------- Forwarded message ----------
From: UCD Graduate '09 None <ucdgrad09@gmail.com>
Date: 2009/2/20
Subject: Wound Healing
To: ucdgrad09@gmail.com
Management of hand injuries &
This document discusses the management of hand injuries and associated infections. Some key points:
- Hand injuries are common, usually affecting young males, and are often caused by domestic or work-related accidents. Proper treatment is important to prevent stiffness.
- Evaluation of hand injuries involves assessing wound characteristics, neurovascular status, and underlying bone or tendon injuries. Management principles aim to preserve the hand and restore function.
- Treatment depends on wound type but typically involves debridement, irrigation, splinting, antibiotics, and reconstruction of tendons, nerves or bone as needed. Complications can include infection, stiffness if not managed properly.
- Specific injuries like bites, foreign bodies, fingertip injuries
Tendon injuries of hand by Dr Saumya Agarwal
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This document discusses open fractures and mangled extremities. It covers the goals of treatment which are to preserve life, limb and function while preventing infection and restoring stability and soft tissue coverage. Open fractures require urgent assessment and debridement to remove non-viable tissue which can be aided by lavage and the use of tourniquets. Skeletal stabilization is also important. Scores can help determine if limb salvage is possible or if amputation is required based on the extent of soft tissue and bone damage. Proper antibiotic use, wound coverage and further reconstruction are also outlined.
Distally-Based Sural Flap
Step-by-step approach for general orthopedist
Presenting in "Regional Hand Meeting 2015" at Ubon Ratchathani, THAILAND
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This document summarizes principles of fracture fixation, methods that provide absolute versus relative stability, and Perren's strain theory. Absolute stability results in primary bone healing without callus formation, while relative stability stimulates callus formation and secondary bone healing. Simple fractures benefit from absolute stability using techniques like lag screws or compression plates, while multifragmentary fractures typically use relative stability with bridging plates, intramedullary nails, or external fixation. The goal is anatomical reduction and rigid fixation for intra-articular fractures, and alignment with relative stabilization for multifragmentary diaphyseal fractures.
Open fractures
Type 1 open fractures have a small wound less than 1cm with minimal soft tissue damage. Type 2 fractures have a wound over 1cm with moderate soft tissue damage. Type 3 fractures are high energy injuries with severe soft tissue damage and bone comminution. The classification correlates with infection risk, healing time, and need for flap coverage. For open fractures, the goals of treatment are to preserve life and limb through debridement, antibiotics, fracture stabilization, and early wound coverage.
Role of arthroscopy
Arthroscopy is a minimally invasive surgical procedure that uses an arthroscope to examine the inside of a joint like the knee. An arthroscope is a thin fiber-optic telescope inserted into the knee joint through small incisions, allowing the surgeon to view the inside of the joint on a video monitor. Common indications for knee arthroscopy include repairing torn cartilage or ligaments like the ACL, removing loose bodies in the joint, trimming damaged tissue, and diagnosing conditions. The procedure allows accurate diagnosis and treatment of many knee problems in a less invasive manner compared to traditional open surgery.
Fracture proximal humerus
This document discusses the management of proximal humerus fractures through K-wire fixation and external fixation. It describes the classification of these fractures, advantages and disadvantages of various treatment methods, and the operative technique for external fixation using K-wires and an external stabilizing system. The goal of management is early mobilization to prevent shoulder stiffness and other complications.
Dr.senthil sailesh- Wound debridement,open fracture,evidence based,
This document discusses wound debridement for open fractures. It recommends:
1) Starting IV antibiotics within 1 hour, such as cefazolin, and continuing for 3-5 days to reduce infection rates.
2) Performing urgent debridement within 6 hours to remove all necrotic tissue from the skin, subcutaneous tissue, fascia, muscle and bone.
3) Irrigating the wound with saline using gravity flow, with a minimum of 3 liters for type 1 fractures up to 9 liters for type 3 fractures. Antiseptics are not recommended.
Anterior cruciate ligament injuries
This document discusses ACL injuries, including evaluation, treatment options, and surgical techniques. It provides details on:
- Tests to evaluate ACL injuries like the Lachman and anterior drawer tests. MRI is recommended if initial tests are positive.
- Surgical timing - it's best to wait 1-3 weeks after injury for swelling to subside before operating to improve visualization.
- Surgical techniques for ACL reconstruction including fixation methods like interference screws and suspensory fixation devices.
- Associated injuries like PCL and MCL tears that may require staged procedures.
- Anatomical considerations like femoral footprints and the double bundle technique to reconstruct both bundles.
Wound management & dressings
wound management, dressings type, dirty and clean wounds, presents plan to manage different types of wounds and options of available dressings.
Femoral neck fractures
Femoral neck fractures most commonly occur in elderly patients due to osteoporosis and osteopenia. Displaced fractures have higher rates of complications like nonunion and osteonecrosis compared to non-displaced fractures. Treatment depends on fracture displacement and patient factors, ranging from non-surgical management of non-displaced fractures to internal fixation, hemiarthroplasty, or total hip arthroplasty for displaced fractures. Large randomized controlled trials have shown that arthroplasty results in better functional outcomes and fewer reoperations compared to internal fixation for displaced fractures in healthy elderly patients.
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The document discusses various types of abdominal incisions used in surgery. It describes midline, vertical, transverse, and oblique incisions. Midline incisions provide good access but have a higher risk of hernia. Transverse incisions have better cosmetic outcomes and less risk of complications like hernia compared to vertical incisions. Specific incisions discussed include Kocher for gallbladder surgery, McBurney for appendicectomy, and Pfannenstiel for pelvic operations. Factors affecting incision healing and potential complications are also outlined.
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Dr.senthil sailesh- Wound debridement,open fracture,evidence based,
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A 9-year-old boy fell from a tree approximately 2 meters high, injuring his left arm and head. On examination, he was found to have a deformity and swelling of his left wrist with tenderness. X-rays revealed a greenstick fracture of the distal ulna with dorsal angulation and an epiphyseal plate injury of the distal radius, consistent with a Salter-Harris Type 1 injury. The boy underwent closed reduction of the fracture with application of a long arm cast to immobilize the injury for 3-6 weeks. Physeal injuries in children can lead to growth disturbances if not properly treated.
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1) A 25-year-old man presented with an open tibia/fibula fracture and underwent irrigation, debridement, and fixation with a tibial nail. However, a week later pseudomonas was cultured from the wound and the nail was removed for further debridement and soft tissue reconstruction.
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The patient is a 70-year-old Thai man who was brought to the hospital after falling off his motorcycle 6 hours prior. He sustained comminuted fractures of the distal and middle phalanges of his right little finger with a partial tear of the lateral band of his right middle finger. In the emergency room, he received IV antibiotics, tetanus prophylaxis, and splinting of his injuries. He then underwent debridement and repair of the lateral band of his middle finger with closed reduction of his little finger fracture. His post-operative care involved IV antibiotics, pain medications, and monitoring of his vital signs.
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This document discusses hand trauma and injuries. It begins by introducing the group members and providing an overview of the topics to be covered, which include structural injuries like cuts, tendon injuries, nerve injuries, bone injuries, amputation and replantation, and hand infections. It then discusses the importance of the hand and approaches to examining a hand trauma patient. The remainder of the document provides details on managing specific types of structural injuries to the hand.
Case discussion ortho jeen
This document discusses the case of a 6-year-old Thai boy who fell from a half-meter height at school, landing on his outstretched right arm and elbow. On examination, he had swelling and deformity of the right elbow with limited range of motion due to pain. X-rays revealed a Gartland Type III closed supracondylar fracture of the left humerus. The boy underwent closed reduction with pinning under fluoroscopy and was placed in a posterior long arm slab for 4 weeks. Supracondylar fractures are common elbow fractures in children aged 5-10 years old and usually result from a fall onto an outstretched hand.
Surgical site infections
This document discusses surgical site infections (SSIs), including definitions, risk factors, prevention, and treatment. Some key points:
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Conference
This case conference discusses a 45-year-old Thai male who was in a motor vehicle accident where he sustained a left humerus fracture. On physical examination, his left arm was tender and swollen with limited range of motion due to pain. X-rays confirmed a closed midshaft left humerus fracture. Treatment options for humerus fractures include non-operative management with a hanging arm cast or functional brace, or operative management with plate fixation or intramedullary nails depending on the fracture pattern and patient factors. Complications can include radial nerve palsy.
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Ortho con supra copy
The document summarizes an orthopedic case of a child who fell from a table and injured his left arm. On physical examination, the child's left elbow was swollen and deformed with limited range of motion due to pain. X-rays revealed a complete transverse fracture at the supracondylar region of the left humerus with total posterior-medial displacement, classified as a Gartland Type III injury. The child underwent closed reduction and percutaneous pinning of the fractured elbow. Post-operatively, the child will need elevation, pain control, range of motion exercises, and pin removal after 3-4 weeks once the fracture has healed. Complications of this type of injury can include nerve damage,
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Acinjury chitphisut-chennisata
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Ortho..
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Extern conference may
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Case conference extern ortho ed1
This case conference discusses a 48-year-old Thai man who presented to the hospital after falling and injuring his right hip. On examination, he had tenderness and swelling of the right hip and thigh with limited range of motion due to pain. X-rays revealed a closed fracture of the right femoral neck. The attending physician provided a provisional diagnosis and treatment plan involving admission, skin traction, pain medication, and monitoring. The discussion then reviewed femoral neck fractures, including risk factors, mechanisms of injury, imaging, classifications, complications, and treatment options such as internal fixation, hemiarthroplasty, or total hip arthroplasty.
Ortho
A 19-year-old Thai male presented to the emergency room after his motorcycle was hit by a car. He reported left knee pain for 30 minutes. On examination, he had a 4x6cm laceration wound on his left knee with exposed bone and active bleeding. Imaging showed an open left patellar fracture. He was diagnosed with an open left patellar fracture and treated empirically with antibiotics. He underwent debridement and tension band wiring in the operating room.
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This document describes the case of a 13-year-old Thai boy who was in a motorcycle accident, resulting in a near amputation of his left index finger. Upon initial examination, he was conscious and coherent with a laceration on his left eyebrow and active bleeding from his injured left index finger. X-rays showed no fractures. He was referred to another hospital, where he underwent surgery to close the stump of his amputated left index finger. The document then provides definitions, classifications, and management guidelines for traumatic finger amputations.
Extern.con.anklefx.chaipat
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Extern conference suthida
- 1. CONFERENCE Ext. Suthida Maneemoon Maharat Nakhon Ratchasima Hospital
- 2. Patient profile • ผู้ป่วยชายไทยคู่ อายุ 38 ปี • ภูมิลาเนาอาเภอโชคชัย จังหวัดนครราชสีมา • สัญชาติไทย นับถือศาสนาพุทธ • Cause of injury: ถูกฟันที่แขนขวา 3 ชม.ก่อนมารพ. • เหตุเกิดเมื่อวันที่ 13 พ.ย. 60 เวลา 12.00น.
- 3. Present illness • 3 ชม.ก่อนมารพ. ผู้ป่วยถูกฟันที่แขนขวาด้วยมีดตัดฟืน2ครั้ง มีแผลฉีกขาดที่แขนขวาลึกถึงกระดูกแขนผิดรูป ขยับไม่ได้ เลือดไหลปริมาณมาก เจ้าหน้าที่นาส่งรพช. แล้วจึง referมา
- 4. Primary survey • A : Can talk, not tender along c-spine • B : Spontaneous breathing, equal breath sound, CCT -ve • C : BP 78/48 mmHg, PR 92 bpm, active bleeding from LW at Rt elbow • D : E4V5M6 , pupil 2 mm RTLBE • E : large LW 20cm deep to bone at Rt elbow
- 5. Adjunct Primary survey • on O2 mask c bag • NSS 1000 ml V load in 15 min (ได้ NSS จากรพช.มาแล้ว 3000 ml) BP หลัง load 103/68 • Hct stat = 11 • G/M group O low titer 2 u v free flow • Retain Foley, NG • FAST –ve at 16.20 • Pressure dressing wound, on splint Rt arm&forarm
- 6. Secondary survey - History • A : ปฏิเสธประวัติแพ้ยาแพ้อาหาร • M : ปฏิเสธประวัติยาใช้ประจา • P : ปฏิเสธประวัติโรคประจาตัว • L : NPO 10.00 • E : ถูกมีดตัดฟืนฟันที่แขนขวา
- 7. Secondary survey – Examination(1) • Head & Maxillofacial: No wound, No facial deformities, no ecchymosis • C-spine & Neck: no wound, can move neck, C-spine not tender • Chest: Equal breath sounds, CCT -ve • Abdomen & Pelvis: no wound, bowel sound positive, soft, not tender
- 8. Secondary survey - Examination(2) • Musculoskeletal: Deformities of Rt arm&forarm , large laceration wound 20 cm deep to bone at Rt elbow(dorsum) with bone fracture, Radial pulses 2+ both, capillary refill < 2 sec, sensory cannot evaluate due to pain Rt wrist can flex but cannot extend, All finger can flex and extend • Neurologic: GCS: E4V5M6 CN: pupils 3 mm RTLBE, full EOM, no facial palsy Motor: grade V all except Rt arm cannot evaluate • Perineum/Rectum: no ecchymosis
- 12. Investigation
- 13. Investigation
- 14. Investigation
- 15. Diagnosis • Open comminuted fracture at Rt distal humerus • Open fracture both bone Rt forarm Gustilo and Anderson classification IIIA
- 16. Management • Resuscitation • Pre-operative lab • Set OR for Debridement + EF span elbow • Antibiotic: cefazolin 1 g iv q6 hr c stat • Consult trauma: R/o vascular injury
- 17. Post-operative • Routine post operative care • Pain control • Serial Hct • Antibiotic: Cefazolin 1 g iv q 6 hr Gentamycin 240 mg iv OD x3 days PGS 3million unit iv q 6 hr
- 18. Post-operative
- 20. Definition • Open fracture is defined as one in which the fracture fragments communicate with the environment through a break in the skin
- 21. History in open fractures • Mechanism of injury – Date, time, type, method of impact, … • Consciousness • Size of wound • Amount of bleeding • Other injuries: often missed • Anti-Tetanus status
- 22. Classification “Gustilo and Anderson classification” • Based on 1) Size of wound 2) Amount of soft tissue injury 3) Presence/absence of NV injury 4) Degree of contamination
- 25. Gustilo Grade I • Low energy • Simple fracture • Skin open by fragment pressure • Wound < 1 cm • No / little contamination www.orthopaedicsone.com/
- 26. Gustilo Grade II • Higher energy • Laceration > 1 cm • No flap / No contusion • Minimal contamination
- 27. Gustilo Grade IIIA • High-energy, • Adequate soft-tissue cover • Contamination • Comminution or segmental fracture
- 28. Gustilo Grade IIIB • High-energy • Extensive soft-tissue stripping • Inadequate cover • Massive contamination • Soft tissue reconstruction is necessary
- 29. Gastilo Grade IIIC • Associate vascular injury • Requires vascular repair
- 30. Higher infection rate Increased contamination – Exposure to soil – Exposure to water – Exposure to fecal material – Exposure to oral material – Gross contamination – Delay > 12 hours
- 31. Principal of treatment • Antibiotic prophylaxis • Urgent and proper wound and fracture debridement • Stabilization of the fracture – External Fixation • Early definitive wound cover
- 32. Management • Gustilo I, II - Can treat by primary internal fixation • Gustilo IIIA - Usually defer internal fixation until soft tissue condition allows • Gustilo IIIB - External fixation - Later, internal fixation • Gustilo IIIC - Vascular repair is a priority - External fixator
- 34. Complications • Wound infection • Osteomyelitis • Non-union • Tetanus infection • Neurovascular injury • Compartment syndrome
- 35. THANK YOU Ext. Suthida Manemoon
Editor's Notes
- Grade I Low-energy, minimal soft-tissue damage wound < 1cm Grade II Higher energy, no flaps needed / no crushing Moderate contamination wound > 1cm Grade III High-energy, flaps needed / crushing Significant contamination Type IIIA : Adequate soft-tissue cover Can cover skin primarily Type IIIB: Inadequate cover Can not cover skin primarily May need skin graft or flap Type IIIC: Vascular injury Requires vascular repair