open fracture

Define as fracture which communicate with external environment, usually involve soft tissues injury usually because of high energy trauma

open # usually associated with contamination.

5 general rules in management of open fracture:
1. Classification of injury
2. Initial mx of soft tissue wound and prevent infection and further damage.
3. Selection of appropriate method of skeletal stabilization
4. Early soft tissue cover
5. early rehab.

Gustilo classification of open fracture
- base on 2 factor
1. The degree of soft tissue injury
2. The degree of contamination.

grade I.
- clean wound <1cm

grade II
- > 1cm but not A/W extensive tissue damage, little contamination.

grade III
- > 10cm, extensive soft tissue damage, severe contamination, fracture usually comminuted, segmental or bone lossirrespective of size of wound.

IIIA - extensive soft tissue but adequate soft tissue to cover fracture bone.
IIIB - extensive soft tissue damage + periosteal stripping, bone exposed.
IIIC - with vascular injury regarless of size of wound.

adopted from basic fracture mx by Mr Yusof etc.

cont...