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SEARCH RESULTS FOR: Open-Fractures

Offene Frakturen: Mechanismen, klinische Befunde und Komplikationen

Open Fractures

$Open Fractures: Mechanisms, clinical features and complications Direct, high-energy force (e.g. vehicle collisions, gunshot) or low-energy force on diseased bone Force applied to bone exceeds strength of bone resulting in periosteal stripping and subsequent soft tissue and neurovascular destruction Open Fractures Also known as “compound fractures” and classified with the Gustilo-Anderson classification system (Types I, II, III), these are fractures in which the skin is penetrated and bone is exposed to the external environment. Comminuted fractures have ≥ 2 breaks in the bone. Inside-out (bone) or outside-in (external) penetration of skin to create a wound Skin tearing creates vacuum-like effect pulling debris into wound Minimal comminution Bone penetrates skin to create a wound < 1 cm in diameter (Type I) Smaller wound creates minimal opportunities for pathogen entry and contamination Moderate comminution Bone penetrates skin to create a wound 1-10 cm in diameter (Type II) Moderate wound creates some opportunity for pathogen entry and contamination Extensive comminution Bone penetrates skin to create a wound > 10 cm in diameter (Type III) Large wound creates ample opportunity for pathogen entry and extensive contamination Type IIIA (adequate soft tissue for bone coverage) Type IIIB (soft tissue damage with periosteal stripping) Type IIIC (vascular injuries, potential amputation) Displacement/shortening/ angulation/rotation of fracture fragment Improper bone healing Bone deformity Authors: Meaghan MacKenzie Holly Zahary Loreman Nojan Mannani Reviewers: Annalise Abbott Usama Malik Michelle J. Chen Dr. Prism Schneider* Dr. Jared Topham* * MD at time of publication Pain & lack of mechanical load bearing axis Inability to weight bear Decreased mobility promotes stasis of venous blood flow & intravascular vessel wall damage Deep vein thrombosis Potential progression to pulmonary embolism Bleeding or inflammation within fascia Muscle atrophy Compartment syndrome (↑ pressure in muscle) ** Open wound exposes bone Infiltration of debris & contaminants Infection of soft tissues or bone (osteomyelitis) Initial injury damages blood vessels Initial injury damages nerves ↓ Sensation distal to injury ↓ Limb function & proprioception ↓ Pulses distal to injury Amputation ↓ Blood flow to bone Avascular necrosis (bone tissue death) Limb ischemia ↓ Blood flow & oxygen delivery to tissues Compartment syndrome** Delayed union (bone healing) on serial radiographs Non-union (bone fails to heal) on serial radiographs **See corresponding Calgary Guide slide on Acute Compartment Syndrome Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Nov 16, 2017; updated Nov 21, 2024 on www.thecalgaryguide.com$