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Musculoskeletal Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
If, during this procedure with an open fracture, the previously exposed bone ends reduce into the wound, this is not of concern although gross contamination should be removed before manipulation. The wound and fracture will undergo full debridement within hours, and any possible contamination will be dealt with then. It is better that the limb alignment is restored for the reasons detailed.
Orthopaedics
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
An open fracture is serious as it exposes the bone to the risk of infection; therefore, an exposed bone should be covered by a sterile dressing at the accident site, and antibiotics should be given to the patient as soon as possible. After the ATLS stabilization (see above) the patient should be taken to the main operating theatre and under anaesthetic and ideal circumstances the wound should be explored, thoroughly cleaned, and all dead tissue (such as skin and muscle) removed. This last procedure is essential because anaerobic bacteria, which live without oxygen, can grow in this tissue; the organism causing gas gangrene is such a bacterium. The surgeon knows when enough tissue has been removed as the cut edges of healthy tissue bleed. Once this stage is complete the fracture is reduced under direct vision and the skin is closed. Skin grafting may be required if debridement leaves a large defect. If the fracture is a closed fracture then the above procedures are unnecessary. If the fracture is displaced it should be reduced and returned to its normal alignment—this should be undertaken under appropriate anaesthesia, general or local, using an image intensifier.
Orthopaedic Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Fracture Reduction➣ Open or closed reduction Open - Fracture site exposed surgically. The fracture is then usually immobilised by internal fixation with plates and screws, or other surgical fixation devices. This is generally referred to as open reduction and internal fixation (ORIF)Closed - the fracture is reduced manually without surgically exposing the fracture site. This may be done with the patient awake or under general anaesthetic. Immobilisation may then be done with a cast, brace or a surgical device place percutaneously or through an incision remote to the fracture site (e.g. percutaneous wires, or intra medullary nailing).
Fracture-related infection: current methods for prevention and treatment
Published in Expert Review of Anti-infective Therapy, 2020
Andrew L Foster, T Fintan Moriarty, Andrej Trampuz, Anjali Jaiprakash, Marc A Burch, Ross Crawford, David L Paterson, Willem-Jan Metsemakers, Michael Schuetz, R Geoff Richards
Following initial debridement, an open fracture should be stabilized and the wound closed primarily or delayed if primary closure is not possible due to the injury severity (Gustilo-Anderson type III injuries). As soft tissue coverage is needed to support fracture healing, prevent nosocomial contamination and aid systemic antibiotic delivery, early reconstructive protocols are preferred [41,42]. Guidelines recommend that open fracture wounds should be covered within 72 h, and no later than 7 days [43].
Interosseous wiring for fragmented proximal phalangeal fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hidetoshi Teraura, Hideki Sakanaka, Hiroyuki Gotani
Patient data and postoperative assessment details are presented in Table 1. Three men and two women with a mean age of 34 (range, 17–68) years were included in the study. A closed fracture occurred in four cases and an open fracture in one case. The delay between injury and surgery was 5 (range, 0–12) days. An average of 3.8 (range, 3–6) bone fragments was recorded. Mean follow-up was 14.8 (range, 8–22) months.
Socioeconomic position is associated with surgical treatment of open fractures of the lower limb: results from a Swedish population-based study
Published in Acta Orthopaedica, 2020
Yamin Granberg, Kalle T Lundgren, Ebba K Lindqvist
Long-term outcomes after an open fracture of the lower limb with extensive soft tissue damage appear to be affected not only by the type of injury and treatment factors, but also by patient-related factors including socioeconomic position (MacKenzie et al. 2006). Our results suggest that socioeconomic position may also influence choice of primary treatment, thus potentially contributing 2-fold to long-term outcomes.