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.they either are or they are not.

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

Gustilo type IIIB open fracture.Angiographic evidence ofvascular injury after traumatic injury

PRINCIPLES OF TREATMENT1. 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.

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

OSTEOMYELITIS

OSTEOMYELITIS IS AN

INFECTION OF BONE,

BONE MARROW AND

SURROUNDED SOFT

TISSUES

Cause

S. Aureus

Enterobacter

Streptococcus

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

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

osteomyelitis.

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

Sequestrum Types

a)Cortical; б)Central; в)Penetrable;г)Total

Clinical exam

Clinical exam

Clinical exam

cutaneous fistula

Diagnosis (X-ray)

• Diagnosis of osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis.

Diagnosis (X-ray)

Diagnosis(CT)

Diagnosis(Scintiography)

Treatment

• surgical debridement.• immobilization• prolonged antibiotic

therapy• hyperbaric oxygen

therapy• enhancing of immunity

status

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.

Surgical debridement

Preparing to the operation

Surgical debridement (technique)

Drainage (passive)

Drainage (active)

IMMOBILIZATION

IMMOBILIZATION

IMMOBILIZATION

IMMOBILIZATION

FILM BULLET

ALL GUNSHOT WOUNDS ARE PRIMERILY CONTAMINATED

MICROORGANISM INVASION

Time

INFECTION

GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION

BANDAGE

GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION

Splintage, antibiotics per os.

GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION

QUICK EVACUATION TO HOSPITAL

GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION

URGENT SURGEORY

THANK YOU !!!

QUESTIONS ?