What Is an Open Fracture?

Scholars at home and abroad attach great importance to the classification of open fractures, and it is related to the choice of treatment methods and prognosis.

Open fracture

When a fracture occurs, the skin and subcutaneous soft tissue covering the fracture site are damaged and ruptured, so that the fracture end is in communication with the outside world, which is called an open fracture. Open fractures are a common and frequently-occurring disease in traumatology orthopedics. With the development of society and the use of modern high-speed tools, open fractures are becoming increasingly serious, the condition is becoming more complicated, and treatment is more difficult.

Classification of open fractures

Scholars at home and abroad attach great importance to the classification of open fractures, and it is related to the choice of treatment methods and prognosis.

Anderson classified open fractures into "type 3" according to the degree of soft tissue injury. Type : The wound does not exceed 1 cm, and the wound is clean. Type : The laceration is longer than 1 cm, but there is no extensive soft tissue injury or skin avulsion. There are extensive soft tissue injuries including lacerations of the skin or flaps, multiple fractures, traumatic amputations and any injuries that require repair of blood vessels. [1]. In 1984, gustilo found inadequacy of this classification in clinical applications and added The type is divided into 3 "subtypes; that is, IIIA: there is still sufficient soft tissue coverage at the fracture, the fracture is multi-stage or comminuted, and IIIB: extensive soft tissue defect, periosteal exfoliation, severe fracture of the fracture, and extensive infection; IIIC: including concurrent Arterial injury or joint dislocation [2]. Anderson-Gustilo's taxonomy is one of the "most commonly used methods in the world."

Clinical diagnosis of open fracture

Chinese scholar Wang Yichen believes that this "classification method has too many reference factors and is inconsistent with each other, which is likely to be misleading. He recommends that according to the trauma mechanism classification, open fractures be divided into: 1) from the inside out (2) Open fracture from outside to inside; (3) Potential open fracture [3]. Zhu Tongbo classified the open fracture according to the size of the wound, the severity of soft tissue damage, the degree of pollution, and the exposed condition of the fracture end. It is 3 degrees. degree open fracture: the skin is punctured by the fracture end from the inside out, the wound is below 3cm, the soft tissue contusion is slight, there is no obvious pollution and the fracture end is exposed; degree open fracture: the wound length is 3-15cm, The fracture end is exposed, with moderate soft tissue damage and obvious pollution; degree open fractures: the wound is more than 15cm, the fracture end is exposed, the soft tissue is damaged, and nerve and blood vessel injuries are often associated, and the pollution is severe [4].

Based on many years of clinical practice, the author classifies fresh open fractures into three levels according to the characteristics of the local injuries of the fractures, and develops a procedure therapy for open fractures of the limbs based on the three-level classification [5]. Grade open fracture: The wound at the fracture is less than 3 cm, and the wound is lightly polluted; Grade open fracture: The wound at the fracture is more than 3 cm, the wound is heavily polluted, or the fracture end is exposed, or the skin is avulsed, and the skin defect; Grade is open Fracture: Open fracture with vascular and nerve damage. In short, no matter how it is classified, it is to better guide clinical treatment; therefore, only by accurately grasping the different clinical characteristics of open fractures, can a reasonable treatment method be selected.

Open fracture symptom of open fracture

Open fracture whole body manifestations

(1) Symptoms of fever: Generally, the body temperature is normal after the fracture, and there is a large amount of bleeding in the fracture. When the hematoma is absorbed, the body temperature slightly increases, but generally does not exceed 38 ° C. When the body temperature of the open fracture increases, the possibility of infection should be considered. (2) Shock symptoms: The main cause of shock caused by fractures is bleeding, especially pelvic fractures, femoral fractures and multiple fractures, and the amount of bleeding can reach 2000ml or more. Severe open fractures or complications of important internal organs can also lead to shock.

Local manifestations of open fractures

Supracondylar fracture of humerus

1. The general manifestation of fractures is local pain, swelling and dysfunction. At the time of the fracture, the bone marrow, periosteum, and surrounding tissues rupture and bleed. Hematomas at the fractures and edema caused by soft tissue damage cause severe swelling of the affected limb, and even tension blister and subcutaneous ecchymosis appear. It can be purple due to the breakdown of hemoglobin. , Cyan or yellow. Severe localized pain in the fracture, especially when moving the affected limb. Local swelling and pain limit the movement of the affected limb. If it is a complete fracture, the injured limb's movement function can be completely lost. 2. Specific signs of fracture (1) Deformity: The displacement of the fracture segment can change the shape of the affected limb, which is mainly shortened, angled or rotated. (2) Abnormal movement: In the normal situation, the limb can't move, and there is abnormal movement after the fracture. (3) Bone abrasion or bony rubbing: After a fracture, when the two fractured ends rub against each other, a bony rattle or bony rubbing can be produced.

Treatment of open fractures

The treatment of open fractures must not only ensure the healing of the fracture, but also avoid the infection of the wound, and also restore the function of the limb as soon as possible. This has been a difficult problem in traumatology orthopedics. The treatment of open fractures includes: debridement, fracture fixation, wound closure, and the application of antibiotics.

Thorough debridement of open fractures

Debridement is the basis for the treatment of open fractures. Thorough debridement is the key to preventing infection. For contaminated fresh open fractures, debridement is performed during the incubation period of bacteria multiplication and invasion of tissues (6-8 hours after injury) to completely remove the infected wounds, inactivated tissues and foreign bodies, and close the wound after cleaning. Can prevent infection. The few remaining bacteria can usually be eliminated by healthy tissue. Therefore, Zhu Tongbo raised the issue of the time limit for debridement. He pointed out that most fresh wounds within 6 to 8 hours can be healed in one stage after thorough debridement and closure; after 8 to 10 hours, the possibility of infection increases; after 24 hours, infection is unavoidable. Therefore, efforts must be made to implement debridement closure within 6 to 8 hours; debridement can still be performed on wounds between 8 to 24 hours, but early closure should be based on wound conditions; wounds over 24 hours are generally not suitable for debridement. At this time, bacteria have multiplied and the wound has been infected. Debridement can destroy the formed granulation tissue barrier to make the infection spread more harmful and useless. You can open the wound to change the medicine, remove obviously necrotic tissue and foreign matter, and make the drainage smooth and tight. Observe and decide on the processing method according to the situation.

Modern debridement especially emphasizes the use of sprayed saline or jet pulse flushing to wash the wound surface, which can loosen foreign bodies and pollutants and easily remove, and the debridement effect is several times higher than other methods. After rinsing, the wound should also be treated with succinate and then soaked with hydrogen peroxide to further kill the pathogenic bacteria. Preventive longitudinal incision of deep fascia is also one of the requirements of modern debridement, which can prevent postoperative osteofascial compartment syndrome.

Management of open fractures

Fracture fixation is the central link in the treatment of open fractures. In addition to the general purpose of maintaining fracture reduction, ensuring fracture healing, achieving early limb exercise, and promoting functional recovery, fracture fixation is more effective for open fractures in eliminating the threat of the fracture end to the skin, reducing the spread of pollution, and facilitating important soft tissues (blood vessels , Nerve, tendon) repair, special significance for wound closure [6].

The fixation of open fractures was mainly external fixation before the 1960s, mainly plaster fixation. Internal fixation was gradually used since the early 1960s, but it was considered a violation of the principle at that time. Because of the good results achieved by internal fixation, people are convinced that internal fixation for open fractures has been accepted by the 1970s. However, there are many problems that are difficult to solve with internal fixation for open fractures. After the mid-1970s, the use of metal frame external fixators to treat open fractures, such as spring crickets, developed rapidly [7], which greatly enriched the means of treating open fractures and significantly improved the cure rate of open fractures.

Treating open fractures is different from closed fractures. It is prone to infection and necrosis. Therefore, the treatment of open fractures requires rapid and minimized re-injury to the tissue. The method of fracture fixation should be simple, rapid and effective. Li Wenfeng [8], Liang Jin et al. [9] pointed out: Although plaster, splint, and bone traction are simple and fast, effective fixation of the fracture cannot be achieved. Abnormal activities at the fracture end not only threaten the healing of wound skin, but also increase the chance of pollution spread. ; Due to the complicated operation of internal fixation methods, the incidence of infections in patients with severely contaminated trauma will also greatly increase due to internal fixation surgery. The external fixator is quick and easy to operate, reliable in fixation, easy to adjust, and convenient for the treatment of local wounds, so it has unique advantages in the treatment of open fractures. Li Qihong [10] believes that the choice of fracture fixation method should be judged based on the patient's "systemic situation, whether the wound can be safely closed and the type of fracture: Type fractures can consider stage closed wounds and internal fixation of fractures; type and type fractures An external fixator should be used for bone external fixation. The latter has the advantages of simple method, small trauma, fracture fixation and easy observation and treatment of wounds.

Open fracture song of the same name

Open Fracture

In Tizzy Bac's "Informed Heart"

lyrics:

I am happy now

Thank you for making me dream

Although my dreams are not so good

Most are still sentimental

But occasionally falls well

While you can still get up

The talented person understands

Bloom in a real smile

This world doesn't want to see

That pure look

But it does nt mean I have to follow

Like the world

We have to get stronger and stronger

Be worthy of your own heart

Run to keep up with this roadside

so let me run run run from you

It's so different

Our path is different

But i will bless you

Hope you won't be afraid at night

If you happen to be

Fallen dog eats shit and is injured

I will control the corners of my twitching mouth

Comfort your life like this

Nothing will never change

Eventually the universe will explode

Don't get stuck in place

Huang Liang's dream is too scary

Girl dream sometimes

But not always

I want to work hard to grow up

Deserves this smiling face

The world is afraid to see

That perfect look

But it does nt mean I have to follow

Broken into a kind

We have to get stronger and stronger

Be worthy of your own heart

Hurry up and keep up the road

so let us run run run from now

Where to fall

Where is a flower blooming

Flowers bloom everywhere

I will become the king of the world

No rain unknown season

No pain, no time to live

I want to sing loudly

My heart is run run run