Post on 15-Jan-2016
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 ?