Best management of open fracture is:
Ans: A (Debridement) Ref: Campbell's Operative Orthopaedics, 11th editionExplanation:Management of Open FracturesThree components of open fracture management are:o Aggressive wound debridement.o Definitive fracture stabilization with internal or external fixation; and o Delayed wound closure.Of these wound debridement is the first and most important step to avoid infection.Tscherne Classification of Open Fracture Management into Four Eras:The era of life preservation / preantiseptic era: Until 20th century.The era of limb preservation: During World War I and World Warll.The era of infection avoidance: Until the mid-1960s when antibiotic came into use.The era of functional preservation: At present; management consists of aggressive wound debridement, definitive fracture stabilization with internal or external fixation, and delayed wound closure.Gustilo, Burgess, Tscherne and AO-ASIF group recommendations for open fractures:1.Treat open fractures as emergencies.2.Perform a thorough initial evaluation to diagnose life-threatening and limb-threatening injuries.3.Begin appropriate antibiotic therapy in emergency department and continue treatment for 2 to 3 days only.4.Immediately debride the wound of contaminated and devitalized tissue, copiously irrigate, and repeat debridement within 24 to 72 hours.5.Stabilize the fracture with the method determined at initial evaluation.6.Leave the wound open (Controversial).7.Perform early autogenous cancellous bone grafting.8.Rehabilitate the involved extremity aggressively.Modified Gustilo-Anderson Classification for Open FracturesType I open fractures: Clean wound less than 1 cm long.Type II open fractures: Laceration more than 1 cm long, no extensive soft-tissue damage, skin flaps or avulsions.Type IMA open fractures: Extensive soft-tissue lacerations or flaps, but maintain adequate soft-tissue coverage of bone, or they result from high-energy trauma regardless of the size of the wound. Includes segmental or severely comminuted fractures, even those with 1 cm lacerations.Type NIB open fractures: Extensive soft-tissue loss with periosteal stripping and bony exposure; usually massively contaminated.Type MIC open fractures: Open fractures with an arterial injury that requires repair regardless of the size of the soft-tissue wound.
Debridement
External fixation
Internal fixation
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Management In Orthopedics