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OPEN (COMPOUND) FRACTURES

OPEN (COMPOUND) FRACTURES. An open fracture can be defined as a broken bone that is in communication through the skin with the environment. Open fractures are much like pregnancy: they either are or they are not.

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OPEN (COMPOUND) FRACTURES

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  1. OPEN (COMPOUND)FRACTURES

  2. An open fracture can be defined as a broken bone that is in communication through the skin with the environment.

  3. Open fractures are much like pregnancy: they either are or they are not.

  4. THE INCIDENCE OF OPEN FRACTURES: AN ANALYSIS OF 960FRACTURES OVER A 6-YEAR PERIOD (Edinburgh, Scotland)

  5. Gustilo type IIIB open fracture. Angiographic evidence of vascular injury after traumatic injury

  6. PRINCIPLES OF TREATMENT 1. Open injuries to bones and joints should be treated as emergencies. 2. The patient should be evaluated carefully to diagnose other life-threatening injuries. 3. Appropriate and adequate systemic antibiotic therapy should begin immediately. 4. The wound should be thoroughly debrided and cleansed. 5. The fracture or joint injury should be stabilized; cancellous bone grafting can be performed immediately or can be delayed. 6. The wound should be appropriately dressed or closed; measures should be taken to facilitate wound drainage. 7. The limb and patient should undergo rehabilitation.

  7. Skeletal traction with a Steinmann pin in the distal femur for management of a femur fracture.

  8. OSTEOMYELITIS

  9. OSTEOMYELITIS IS AN INFECTION OF BONE, BONE MARROW AND SURROUNDED SOFT TISSUES

  10. Cause • S. Aureus • Enterobacter • Streptococcus

  11. Pathogenesis Microorganisms may infect bone through one or more of three basic methods: via the bloodstream, contiguously from local areas of infection (as in cellulitis), penetrating trauma, including iatrogenic causes such as joint replacements or internal fixation of fractures root-canaled teeth

  12. Areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis.

  13. A SEQUESTRUM is a piece of dead bone that has become separated during the process of necrosis from bone.

  14. Sequestrum Types Cortical; б)Central; в)Penetrable;г)Total

  15. Clinical exam

  16. Clinical exam

  17. Clinical exam cutaneous fistula

  18. Diagnosis (X-ray) Diagnosis of osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis.

  19. Diagnosis (X-ray)

  20. Diagnosis(CT)

  21. Diagnosis(Scintiography)

  22. Treatment • surgical debridement. • immobilization • prolonged antibiotic therapy • hyperbaric oxygen therapy • enhancing of immunity status

  23. Treatment (fistulo-sequestr-necrectomia) A SEQUESTRUM is a piece of dead bone that has become separated during the process of necrosis from bone. It is a complication (sequelae) of osteomyelitis.

  24. Surgical debridement

  25. Preparing to the operation

  26. Surgical debridement (technique)

  27. Drainage (passive)

  28. Drainage (active)

  29. IMMOBILIZATION

  30. IMMOBILIZATION

  31. IMMOBILIZATION

  32. IMMOBILIZATION

  33. FILM BULLET

  34. ALL GUNSHOT WOUNDS ARE PRIMERILY CONTAMINATED

  35. MICROORGANISM INVASION Time INFECTION

  36. GENERAL PRINCIPLES OF OSTOMYELITISPREVENTION • BANDAGE

  37. GENERAL PRINCIPLES OF OSTOMYELITISPREVENTION • Splintage, antibiotics per os.

  38. GENERAL PRINCIPLES OF OSTOMYELITISPREVENTION • QUICK EVACUATION TO HOSPITAL

  39. GENERAL PRINCIPLES OF OSTOMYELITISPREVENTION URGENT SURGEORY

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