Contents
Definition
- fractured bone in communication with the external environment
Emergency Measures
- tetanus status
- IV antibiotics
- splint fracture
- irrigate open wound with physiological solution (9-12 L of NS)
- debridement: removal of foreign material, devitalized tissue (the 4 C’s), old blood and cover wound with sterile dressings
- NPO and prepare for OR (bloodwork, consent, ECG, CXR)
-operative irrigation and debridement within 24 hours to decrease risk of infection
-traumatic wound usually left open to drain
-re-examine with repeat I&D in 48 hrs
|
4 C’s of Non-Viable Tissue |
|---|
|
Colour |
Gustilo Classification of Open Fractures
|
Gustilo Grade |
Length of Open Wound |
Description |
Antibiotic Regimen |
|---|---|---|---|
|
I |
<1cm |
Minimal contamination and soft tissue injury |
1st generation cephalosporin x48hrs. |
|
II |
1-10cm |
Moderate contamination |
Gram-negative coverage (gentamicin) for at least 72hrs. |
|
III |
>10cm |
Gross contamination |
*For soil contamination, penicillin is provided for Clostridial coverage |
|
III |
A |
Moderate periosteal stripping, adequate soft tissue coverage |
|
|
III |
B |
Marked periosteal stripping, inadequate soft tissue coverage |
|
|
III |
C |
Open # with vascular injury that requires repair |
*Any highly comminuted #, shotgun blast, farmyard/soil contamination or # > 8hrs. old is immediately classified as Grade III
Tetanus
|
Tetanus Hx |
Clean Wound |
Dirty Wound |
|
|
Td TIG |
Tg TIG |
|
Unknown or < 3 Td doses |
Y N |
Y Y |
|
> 3 Td doses |
N |
N |
|
|
Y if > 10 yrs since last dose
Y if > 5 yrs since last dose.
(Td = 0.5 ml absorbed tetanus toxoid. TIG = 250 units tetanus immune globulin.)