TRAUMA CARE MANAGEMENT

Dr Biren Nadkarni has specialization in Trauma Care Management

An Open Fracture consists of an open wound or crack in the skin where the broken bone is located. This wound is usually caused by a bone fragment that breaks through the skin at the injury time. In recent years, the management of open fractures has developed in many fraction centres in hospitals worldwide, implementing algorithms and ortho-plastic management.

An open fracture involves a procedure distinct from an open wound closed fracture. Bacteria from the soil and other pollutants may penetrate the damage and cause infection until the skin is fractured.

Conditions

The seriousness of open fractures varies significantly. There is noticeable skin loss in many high-energy burns, and the bone will swell up from the cut. The wound will not be bigger than a puncture in many other situations. In all cases, there is significant damage to the bone’s soft tissues, including muscles, tendons, nerves, veins, and arteries. For this purpose, an open fracture is called an acute fracture with available damage in the region.

The extent of an open divide depends on many factors, such as:

  • The size and volume of fractures
  • Harm to soft tissues
  • The position of the wound and the healthy blood flow of soft tissues in the field.

Any high-intensity incident – such as a shooting or motor car collision – lead to many open fractures. These patients are often wounded more in various areas of the body.

Risks

  • Infection

It is the most prominent risk with open fractures. At the time of the injury, bacteria penetration into the wound is a consequence of infection. The infection may happen early during healing or much later after recovering both the damage and the fracture. Bone infection may develop gradually and lead to further surgery.

  • Nonunion

Many open fractures can be impossible to repair because of blood damage across the bones as the injury happens. Further surgery may be required, including bone grafting to the fracture area and repeat inner fixation, if the bone does not heal.

  • Compartment Syndrome

Such a painful disorder is established as the wounded arm or leg swells, and the muscles intensify pressure. When left untreated, the syndrome of the compartment can cause permanent tissue damage and function loss.

Procedure

According to Dr Biren Nadkarni, an open fracture is when the bone splits and enters into the skin. Open fractures need immediate healthcare because the bone can lead to inflammation, and the healing of the wound can also cause complications.

To segregate open fractures, Gustilo Anderson is the system used. This naming scheme’s additional advantage is that it details how the infection has occurred and the estimated time to repair the fracture completely.

  1. Grade I 

It can be identified that the injury is associated with the broken bone in some of the cases. This can be known by injecting a fluid into the fracture site and monitoring how it is extracted through the cut.

  1. Grade II
  2. An open wound of more than 1 cm occurs in such a fracture, and even soft tissues around the injury are affected.
  1. Grade III

The related injuries are very severe with this form of fractures. Grade III is divided into four sub-categories.

  • Grade III A- Fractures of this type consist of high-energy lesions associated with segmented bones and soft tissue injuries. Even if the wound is not big, the high fractures are classified as grade III-A.
  • Grade III B – Bone exposure and severe losses to soft tissues are found with these forms of fractures.
  • Grade III C – Significant artery injury is affected by this form of fracture.

As the bone detaches from the injury, the bacteria may likely travel through the open end of a wound, leading to bone infection and turn out to be a complicated issue. Standard surgeons prefer surgery in 6 hours. The management of open fractures, the latest thought in this area indicates that the procedure can occur within 24 hours of the accident.

You should apply external fixation on the wounded part if you are not ready for permanent implants and if the wound and broken bones are not ready.

Treatment

  • Debridement and Irrigation

As per Dr Biren Nadkarni, many patients with open fractures undergo a treatment often referred to as “Debridement and Irrigation.” It is the first step to manage infection risks. Your doctor will remove all harmful and infected wounds during debridement along with infected tissue. If the injury is thin, the doctor may need to expand the damage to all affected bone and soft tissue regions. The wound is either cleaned out or rinsed with a huge amount of saline solution.

  • Internal Fixation

The doctor will put implants of metal on or inside a fractured bone, like plates, tubes, or screws. The bone orientation is maintained and preserved as the fracture heals through the implants. Internal fixation can be done if:

  1. The injury is clean.
  2. The skin or tissue is minimally damaged.
  3. The fractured bone fragments should be positioned correctly.
  • External Fixation

In this process, the surgeon implants metal screws or pins into the bone above the fracture location and below it.

Pre and Post Surgery

Management of open fractures is generally done in the operation room. It is necessary to go to the surgeon as quickly as possible to flush out the open wound to avoid infection.

The time it takes to heal a fracture depends on the complexity and the type of the injury. Few fractures can take more time to cure. Slower curves can also be encountered in people with medical problems like diabetes or peripheral artery disease.

Dr Biden Nadkarni says your support is a significant factor in the successful treatment of an open fracture. You will be given a recovery schedule from a physician or a physical therapist.

Precautions

  • Nutrition and light

A sufficient supply of calcium for healthy bones is essential for the human body. The good sources of calcium are cheese, milk, dark green leafy vegetables and yogurt.

Our body needs Vitamin D to digest calcium – sunlight exposure, eggs, and fatty fish are healthy ways to get vitamin D.

  • Exercises

It is necessary to do more weight-bearing exercises to provide strength to your bones and make them stronger.

Consultation

Open fractures frequently occur due to collisions in motor cars, plane crashes,  sports injuries, etc. Consult the orthopedic doctor immediately after injury for management of open fractures. Usually, a tetanus injection is given if the patient has no information regarding the given treatment.  The doctor cleans the injury and prescribes medication and antibiotics to control the wound.

Consult Dr Biren Nadkarni for Trauma Care Management

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