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
- Treatment:
- C&S
- 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.
