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Open Fractures - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing classification of open fractures of the tibia. Open fractures occur when the fractured bone penetrates through the skin. Open fractures typically occur by high energy injuries such as car crashes, falls, or sports related injuries. The Gustillo-Anderson classificaton of open tibial fractures describes the amount of enegry, the extent of soft-tissue injury and the extent of contamination or determination of the open fracture severity. There are three types of open fractures: •Type I: low energy clean wound that is usually less than 1 cm in length with minimal soft tissue injury and minimal bone contamination. •Type II: wound length 2-10 cm with moderate soft tissue damage and wound contamination. •Type III: high energy wound usually greater than 10 cm in length with extensive muscle devitalziation. Wound is highly contaminated with extensive soft tissue damage. Type III fractures can also include open segmental fractures, open fractures in a highly contaminated environment such as in farm yards or associated with high velocity gun shot wounds. These wounds are classified as type III regardless of the size and level of contamination. Adequate emergency debridement of the devitalized tissue is required to prevent wound infection. Type III is further classified into: Type III A: severe soft tissues injury, soft tissue coverage of the bone is possible. Type III B: severe loss of soft tissue loss, bone coverage is not possibile. Maybe moderate to severe bone comminution. Usually requires a local or distant flap. Open fractures in the middle part of the tibia can be reconstructed by using a soleus muscle flap. Open fractures in the proximal part of the tibia can be reconstructed by using a medial gastrocnemius muscle flap. Open fractures in the distal part of the tibia can be reconstructed by using a latissimus dorsi free flap. Type III C: vascular injury requiring repair or amputation. Example of type III C proximal tibial open fracture with injury to the popliteal artery. Amputation is required if: •Extensive vascular injury •Muscle & tissue ischemia of more than 8 hours (Warm ischemia time) •No plantar sensation due to posterior tibial nerve injury •Can use mangled extremity severity score. Treatment of grade III open fractures: •Irrigation and debridement of devitalized tissue. •Reduction of fractured bone fragment •Stabilization with extrenal fixation, rods or internal fixation with plates and screws depending upon the condition of the soft tissue, level of contamination and the location of the fracture. •Bone graft is used to promote healing process (usually after 6 weeks of initial stabilization) and a bone graft susbstitue may also be used. •Exchange rodding can enhance healing at the site of nonunion Become a friend on facebook:   / drebraheim   Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC