open (compound) fractures. an open fracture can be defined as a broken bone that is in communication...
TRANSCRIPT
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OPEN (COMPOUND)
FRACTURES
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An open fracture can be defined as a broken bone that is in communication through the skin with the environment.
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Open fractures are much like pregnancy:
they either are or they are not.they either are or they are not.
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THE INCIDENCE OF OPEN FRACTURES: AN ANALYSIS OF 960FRACTURES OVER A 6-YEAR PERIOD (Edinburgh, Scotland)
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Gustilo type IIIB open fracture.Angiographic evidence ofvascular injury after traumatic injury
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PRINCIPLES OF TREATMENT1. Open injuries to bones and joints should be treated as
emergencies.2. The patient should be evaluated carefully to diagnose other life-
threatening injuries.3. Appropriate and adequate systemic antibiotic therapy should
begin immediately.4. The wound should be thoroughly debrided and cleansed.5. The fracture or joint injury should be stabilized; cancellous bone
grafting can be performed immediately or can be delayed.6. The wound should be appropriately dressed or closed; measures
should be taken to facilitate wound drainage.7. The limb and patient should undergo rehabilitation.
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Skeletal traction with a Steinmann pin in the distal femur for management of a femur fracture.
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OSTEOMYELITIS
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OSTEOMYELITIS IS AN
INFECTION OF BONE,
BONE MARROW AND
SURROUNDED SOFT
TISSUES
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Cause
S. Aureus
Enterobacter
Streptococcus
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Pathogenesis
Microorganisms may infect bone through one or more of three basic methods: •via the bloodstream, contiguously from local areas of infection (as in cellulitis), •penetrating trauma, including iatrogenic causes such as joint replacements or internal fixation of fractures •root-canaled teeth
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Areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic
osteomyelitis.
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A SEQUESTRUM is a piece of dead bone that has become separated during the process of necrosis from bone.
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Sequestrum Types
a)Cortical; б)Central; в)Penetrable;г)Total
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Clinical exam
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Clinical exam
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Clinical exam
cutaneous fistula
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Diagnosis (X-ray)
• Diagnosis of osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis.
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Diagnosis (X-ray)
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Diagnosis(CT)
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Diagnosis(Scintiography)
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Treatment
• surgical debridement.• immobilization• prolonged antibiotic
therapy• hyperbaric oxygen
therapy• enhancing of immunity
status
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Treatment (fistulo-sequestr-necrectomia)
A SEQUESTRUM is a piece of dead bone that has become separated during the process of necrosis from bone.
It is a complication (sequelae) of osteomyelitis.
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Surgical debridement
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Preparing to the operation
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Surgical debridement (technique)
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Drainage (passive)
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Drainage (active)
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IMMOBILIZATION
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IMMOBILIZATION
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IMMOBILIZATION
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IMMOBILIZATION
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FILM BULLET
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ALL GUNSHOT WOUNDS ARE PRIMERILY CONTAMINATED
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MICROORGANISM INVASION
Time
INFECTION
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GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION
BANDAGE
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GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION
Splintage, antibiotics per os.
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GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION
QUICK EVACUATION TO HOSPITAL
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GENERAL PRINCIPLES OF OSTOMYELITISGENERAL PRINCIPLES OF OSTOMYELITISPREVENTIONPREVENTION
URGENT SURGEORY
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THANK YOU !!!
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QUESTIONS ?