OPEN FRACTURE

History

20 y/o Malay male

• Alleged MVA (MB vs MB), directly hit at the right leg

when MB from opposite site make sudden turn to

right,  On his way to friend house

• Landed on hip

• Fall on right side

• Post trauma sustained pain right leg

• Noted deformity and protruding bone at mid part of

leg, unsure size, active bleeding.

• Fall on the road, not on the sand

• Unable to ambulate due to pain

• Unable to plantarflex/ dorsiflex due to pain

• Able to move all toes

• Numbness over right lower limb but no shooting

pain

• Otherwise, no LOC, no ENT bleeding, no SOB, no

Chest pain, no abdominal pain.

• Primary and secondary survey

» Scalp examination - Any hematoma/

bleeding

» Any EnT bleeding

» Chest spring negative

» No abdominal tenderness

» Pelvic spring negative

• Classification (Gustillo Anderson)

Type 1 - wound < 1cm

Type 2 - wound 1cm - 10 cm

Type 3 big wound, classified

3A : wound that adequate tissue coverage

3B : wound that need flap to cover

3C : open wound that involve vessel that need vascular repair

• Management

1. ABCD

2.  Compression if active bleeding (tempat kejadian)

3. Immobilize (splinting)

4. Anti tetanoid toxic injection

5. Irrigate with copious normal saline - to reduce

bacterial load

6. Cover with antibiotic - depend on severity, we give

for prophylaxis reason

» IV Cefuroxime (cover more gram neg)

» IV Flagyl (cover anerobic)

» IV Gentamicin (cover aerobic gram negative)

7. Immobilization - usually by skeletal traction

(calceneum/ high tibial pin)

8. External fixation - till wound heal (open fracture then

become closed fracture.

9. Definitive plan - plating/ internal fixation later