Chapter 32 - Trauma
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Patient presents to ED with an open fracture. The wound is 1.4 cm in length. The fracture happened 2 hours ago. There is minimal or no comminution. Wound is clean. How would you classify this and how would you treat?
This is a gustillo and anderson type II
- Type I
- fx with open wound <1cm
- clean, minimal soft tissue necrosis
- fx is usually transverse or short oblique
- minimal or no comminution
- Type 2
- Same as above but > 1 cm
- Type 3
- Fx with extensive open wound
- contamination and/or necrosis of skin, muscle, N/V structures and soft tissue
- Often comminution
- A: Adequate soft tissue coverage of bone
- B: Extensive soft tissue loss with periosteal stripping and bone exposure
- C: Injury with arterial injury requiring microvascular repair
- wound debridement/irrigation
- Fx stabilization
- tetanus prophylaxis
- antibiotics (cefazolin 1-2 g IV followed by 1g IVPB q8h until cultures are available)
- VASCULAR EVAL: Fluroescein, a non-toxic dye, administered IV and observed under UV light after 10-20 minutes.
What is an incomplete fracture in which cortex on only one side is disrupted; seen in children due to their soft bones?
What is the JAHSS classification used for?
- To classify turf toe.
- Type 1
- -dorsal dislocation of the proximal phalanx in which the metatrsal head punctures through the plantar capsule.
- -intersesamoidal ligament is intact and there are no fractures
- -deformity is tight and difficult to close reduce
- Type IIA
- Same as above except:
- the intersesamoidal ligament is ruptured
- the deformity is loose and easier to close reduce
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