OPEN FRACTURE

SURGERY DEPARTMENT MEDICAL FACULTY YARSI UNIVERSITY JAKARTA 2008

Open fractures
Communication between fracture site and

external environment High risk of infection, delay or nonunion Clinical symptoms

Pain, deformity, inability to move, skin wound with bleeding

 Physical examination

Shock? Wound Deformity Contamination? Assess soft tissue injury Neurovascular compromise?

Severe soft tissue injury

Vascular compromise

Vascular compromise

 Radiographic examination

Gold standard

 Classification : Gustilo and Anderson

Type I : skin wound<1cm clean no contamination

Type II

skin wound>1cm soft tissue damage not extensive no flaps or avulsion no fracture comminuting

Type II open fracture contd

Type III

high energy injury Extensive soft tissue damage severe crushing injury vascular injury requiring repair severe contamination, farm injuries fracture comminuting including segmental fractures or bone loss irrespective skin wound size

IIIA

adequate soft tissue cover of bone despite extensive soft tissue damage

IIIB

extensive soft tissue injury with periosteal stripping and bone exposure Mayor wound contamination

IIIC

open fracture with vascular injury requiring repair

IIIC open fracture contd

IIIC open fracture contd

IIIC open fracture contd

OREF and vascular repair for highly comminutive open fracture IIIC

Thank you