1887

Open fractures

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Abstract

An open fracture is diagnosed where there is communication between the fracture fragments and the external environment. These fractures occur when sharp bone fragments penetrate the skin or when a traumatic injury causes damage to the skin and soft tissues resulting in exposure of the fracture site. This chapter looks at open fracture management; shearing injuries; prognosis.

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Figures

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12.2 Fluid set-up for wound lavage.
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12.3 (a) Preoperative preparation of an open fracture of the left radius and ulna in a 4-year-old Springer Spaniel. The fracture was stabilized with a seven-pin type 1b external skeletal fixator. (b) Radiograph of the same patient 8 weeks postoperatively, showing satisfactory callus formation at the radial and ulnar fracture sites. Note the bone lucency around the most proximal fixation pin, indicating loosening of the pin.
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12.4 (a) Radiograph of a comminuted mid-diaphyseal tibial fracture in a 6-year-old Border Collie. Note the proximal tibial diaphysis protruding through the soft tissue envelope. The bone fragment was completely denuded of soft tissue attachment. (b) Immediate postoperative radiograph of the fracture managed with fragment removal and orthogonal dynamic compression plate and screw fixation.
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12.5 (a) Proximal tibial physeal fracture in a 10-week-old Border Terrier that had been kicked by a horse. There was denuding of the metaphyseal and proximal diaphyseal periosteum and cranial tibial muscle avulsion. (b) Postoperative radiograph showing reduction and stabilization with multiple Kirschner wires. Note the concomitant femoral diaphyseal fracture. (c) Radiograph taken 6 weeks postoperatively showing sequestration of the entire proximal tibia. The discontinuity of the cortices in the mid-diaphyseal region of the tibia resulted from the lack of blood supply (rather than trauma). The distal end of the sequestrum was not originally fractured. (Courtesy of E Maddock)
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12.6 Open distal tibial physeal fracture with concurrent tarsocrural luxation. This patient had a concomitant distal femoral physeal fracture. Flystrike is also present. Due to devascularization of the distal tibial epiphysis, amputation was considered the most appropriate treatment option.
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12.7 Degloving injury of the second digit of the right thoracic limb (in the same patient as in Figure 12.3 ). There was luxation of the metacarpophalangeal joint with concurrent soft tissue and bone loss exposing the first phalanx (arrowed) and the base of the second phalanx. The injury was managed as an open wound, which led to healing by the development of a functional ankylosis of the metacarpophalangeal joint.

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