Which of the following injuries can be classified as Gustilo Anderson Grade III injuries?
Ans- C Ref- Complete version Gustilo Type I II IIIA IIIB IIIC Images Energy Low energy Moderate High High High Wound Size < 1 cm > 1cm >10cm >10cm >10cm Soft Tissue Minimal Moderate Extensive Extensive Extensive Contamination Clean Moderate contamination Extensive Extensive Extensive Fracture Pattern Simple fx pattern with minimal comminution Moderate comminution Severe comminution or segmental fractures Severe comminution or segmental fractures Severe comminution or segmental fractures Periosteal Stripping No No Yes Yes Yes Skin Coverage Local coverage Local coverage Local coverage including Requires free tissue flap or rotational flap coverage Typically requires flap coverage Neurovascular Injury Normal Normal Normal Normal Exposed fracture with arterial damage that requires repair Antibiotics 1st generation cephalosporin for 24 hours after closure 1st generation cephalosporin for gram positive coverage. Aminoglycoside (such as gentamicin) for gram negative coverage in type III injuries the cephalosporin/aminoglycoside should be continued for 24-72 hours after the last debridement procedure Penicillin should be added if concern for anaerobic organism (farm injury) aminoglycoside (such as gentamicin) for gram negative coverage 1st cephalosporin (ancef) for gram positive coverage. the cephalosporin/aminoglycoside should be continued for 72 hours after the last debridment procedure penicillin should be added if concern for anaerobic organism (farm injury Antibiotics (other considerations) Flouroquinolones should be used for fresh water wounds or salt water wounds can be used if allergic to cephalosporins or clindamycin Doxycycline and ceftazidime can be used for salt water wounds Antibiotic Indications for Open Fractures Gustillo Grade I and II 1st generation cephalosporin Gustillo Grade III 1st generation cephalosporin + aminoglycoside traditionally recommended, but there is no evidence in the literature to support its use With farm injury / bowel contamination 1st generation cephalosporin + aminoglycoside + PCN add PCN for clostridia Duration initiate as soon as possible increased infection rate when antibiotics are delayed > 3 hours from time of injury continue for 72 hours after I&D 48 hours after each procedure Tetanus booster if not up to date
Open fracture with clean wounds less than 1 cm long
Open fractures with a laceration more than 1 cm long usually up to 10 cms, without extensive soft tissue damage, flaps or avulsions
Open segmental fractures, open fractures with extensive soft tissue damage,traumatic amputation
Compartment syndrome with an open fracture