Case ReportJonathan Kneib

PGY-2

19 yo male wth no significant PMH comes in to ED s/p texting while on a pogo stick and sustaining a fall. Patient has an obvious ankle deformity.

Vitals Temperature 37

HR 82

BP 125/82

O2 99% on RA

Secondary Survey 1. check distal pulses, capillary refill

2. sensation

3. ROM

Ankle Inspection Palpate base of 5th metatarsal (Jones, Dancers)

Palpate navicular

Palpate Achilles tendon and do Thompson test (Achilles rupture)

Palpate bony prominences (medial and lateral malleoli)

Palpate proximal fibula (Maisonneuve)Think referred pain -see reference 1

Things to Do Antibiotics and tetanus

XR

Remove gross contamination and apply moist sterile dressing

Photograph

Reduce/Splint the limb

Arrange for urgent surgical debridement/washout and stabilization of the fracture

Gustillo Type I - less than 1 cm and relatively clean, no

crushing injury

Gustillo Type I

Gustillo Type II - longer than 1 cm with moderate

contamination, slight to moderate crushing

Gustillo Type II

Gustillo Type III - extensive damage to soft tissue and high degree

of contamination and a great deal of communtion and instability

Gustillo IIIA - IIIA: soft tissue can cover bone

Gustillo Type III A

Gustillo IIIB IIIB: loss of soft tissue and will require flap

Gustillo Type IIIB

Gustillo III C IIIC: arterial injury, regardless of degree of

soft tissue loss

Gustillo Type III C

Antibiotics Gustillo I and II

- 1st generation cephalosporin (Ancef)

- if allergy: clindamycin or vancomycin

Gustillo III - in addition to above add an aminoglycoside

(Gentamycin)

If a farm injury or open bowel contamination - add penicillin (to cover clostridium)

Pearls When covering an open fracture use pads

soaked in saline

Pearls Six Hour Golden Rule

Orthopedic goal to have operative repair of open fracture within 6 hours

Work Cited Here?, -Why Are You, -General Tips, -Pearls

And Pitfalls From Head To Toe, and -Summary Of Really Important Stuff. ORTHOPEDIC PEARLS & PITFALLS (n.d.): n. pag. Web.

"Gustilo Classification." - Trauma. N.p., n.d. Web. 03 Aug. 2015.