Compound FracturesManagement

General & Local

Early

• Medico legal record• Pt’s identification marks, Pt. bought by,

Detailed history & injury notes , Police information

• Investigations –Hemogram, BSL, BUN, S. Creatinin, Blood grouping, X-ray, USG, CT scan

• Catheterization• Renal perfusion - Hypotension, crush syndrome

Local

• As soon as patient is hemo dynamically stable at the EARLIEST

• Cleaning

• Debridement

• Stabilization

• Under Anesthesia

Cleaning

• Repeated

• Using about 3 to 4 liters of normal saline till all the foreign material is removed.

• May add mild detergent to Normal Saline

• Addition of antiseptics, H2O2, Not recommended as it may injure soft tissues & discoloration will confuse the vitality signs

Debridement

• Excision of all dead tissue

• Excision of all contaminated tissues with foreign material which can not be removed by cleaning

• Including every piece of bone without soft tissue attachment in spite of its size

• Soft tissue till bleeding edge

• Muscles till bleeding contractile pink muscle

• Send Culture Swab For C & S

• NO Sutures

stabilization

• Debridement repeated after 24 hours and there after till no dead tissue remains

• Splints• Simple• Traction Splints- Fixed traction, Dynamic traction

• Plasters • Slabs,

• Casts, Window dressing

External Fixators

• Uni- plainer• Simple

• Complex Joint spanning

• Multi-plainer• JESS• Ring

External Fixator

External FixatorComplex

Ring Fixator