Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Systems
- 1 Infective Endocarditis
- 2 Myocarditis and Pericarditis
- 3 Dental and Odontogenic Infections
- 4 Systemic Diseases Causing Fever and Rash
- 5 Otitis Media
- 6 Otitis Externa
- 7 Sinusitis
- 8 Supraglottitis
- 9 Pharyngitis and Tonsillitis
- 10 Deep Neck Space Infections
- 11 Mumps
- 12 Peritonitis
- 13 Viral Hepatitis
- 14 Infectious Biliary Diseases: Cholecystitis and Cholangitis
- 15 Acute Infectious Diarrhea
- 16 Diarrhea in HIV-Infected Patients
- 17 Ulcerative Sexually Transmitted Diseases
- 18 Nonulcerative Sexually Transmitted Diseases
- 19 Vulvovaginitis
- 20 Male Genitourinary Infections
- 21 Adult Septic Arthritis
- 22 Hand Infections: Fight Bite, Purulent Tenosynovitis, Felon, and Paronychia
- 23 Osteomyelitis
- 24 Open Fractures
- 25 Spinal Infections
- 26 Prosthetic Joint Infections
- 27 Diabetic Foot Infections
- 28 Plantar Puncture Wounds
- 29 Periocular Infections
- 30 Conjunctival and Corneal Infections
- 31 Uvea, Vitreous, and Retina Infections
- 32 Community-Acquired Pneumonia
- 33 Tuberculosis
- 34 Influenza
- 35 HIV-Associated Respiratory Infections
- 36 Arthritis in the Acute Care Setting
- 37 Lower Urinary Tract Infection in Adults
- 38 Pyelonephritis in Adults
- 39 Fever and Headache: Meningitis and Encephalitis
- 40 Fever and Focal Cerebral Dysfunction
- 41 Fever and Acute Weakness Localizing to the Spinal Cord
- 42 Altered Mental Status in HIV-Infected Patients
- 43 Bacterial Skin and Soft-Tissue Infections
- Part II Pediatrics
- Part III Special Populations
- Part IV Current Topics
- Part V Overview of Antibiotics
- Part VI Microbiology/Laboratory Tests
- Part VII Infection Control Precautions
- Index
- References
24 - Open Fractures
from Part I - Systems
Published online by Cambridge University Press: 15 December 2009
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Systems
- 1 Infective Endocarditis
- 2 Myocarditis and Pericarditis
- 3 Dental and Odontogenic Infections
- 4 Systemic Diseases Causing Fever and Rash
- 5 Otitis Media
- 6 Otitis Externa
- 7 Sinusitis
- 8 Supraglottitis
- 9 Pharyngitis and Tonsillitis
- 10 Deep Neck Space Infections
- 11 Mumps
- 12 Peritonitis
- 13 Viral Hepatitis
- 14 Infectious Biliary Diseases: Cholecystitis and Cholangitis
- 15 Acute Infectious Diarrhea
- 16 Diarrhea in HIV-Infected Patients
- 17 Ulcerative Sexually Transmitted Diseases
- 18 Nonulcerative Sexually Transmitted Diseases
- 19 Vulvovaginitis
- 20 Male Genitourinary Infections
- 21 Adult Septic Arthritis
- 22 Hand Infections: Fight Bite, Purulent Tenosynovitis, Felon, and Paronychia
- 23 Osteomyelitis
- 24 Open Fractures
- 25 Spinal Infections
- 26 Prosthetic Joint Infections
- 27 Diabetic Foot Infections
- 28 Plantar Puncture Wounds
- 29 Periocular Infections
- 30 Conjunctival and Corneal Infections
- 31 Uvea, Vitreous, and Retina Infections
- 32 Community-Acquired Pneumonia
- 33 Tuberculosis
- 34 Influenza
- 35 HIV-Associated Respiratory Infections
- 36 Arthritis in the Acute Care Setting
- 37 Lower Urinary Tract Infection in Adults
- 38 Pyelonephritis in Adults
- 39 Fever and Headache: Meningitis and Encephalitis
- 40 Fever and Focal Cerebral Dysfunction
- 41 Fever and Acute Weakness Localizing to the Spinal Cord
- 42 Altered Mental Status in HIV-Infected Patients
- 43 Bacterial Skin and Soft-Tissue Infections
- Part II Pediatrics
- Part III Special Populations
- Part IV Current Topics
- Part V Overview of Antibiotics
- Part VI Microbiology/Laboratory Tests
- Part VII Infection Control Precautions
- Index
- References
Summary
INTRODUCTION
Open fractures occur when the involved bone and surrounding soft tissues communicate with the outside environment because of a traumatic break in the overlying skin. Many open fractures are a result of high-energy trauma and are associated with severe soft-tissue injury. Lower energy open fractures occur when the skin break is caused by an “inside-out” injury. This occurs when a fractured end of the bone penetrates the overlying skin.
EPIDEMIOLOGY
Fractures represent a major public health problem. The lifetime risk of fracture up to age 65 years is one in two, and every year, 1 in 118 people younger than 65 years of age sustains a fracture. Approximately 2% of all fractures and dislocations are open.
CLINICAL FEATURES
Open fractures can be classified according to the Gustilo classification system (Figures 24.1, 24.2, and 24.3; Table 24.1).
DIFFERENTIAL DIAGNOSIS
Key clinical questions that may help in the diagnosis of open fractures are:
Is an open fracture the source of visible bleeding?
How large is the wound and how severe is the soft-tissue damage?
Are the joints above and below affected?
What is the neurovascular status of the affected limb?
TREATMENT AND PROPHYLAXIS
The rate of infection despite antibiotic administration in type I fractures range from 0% to 2%, in type II fractures from 2% to 10%, and in type III fractures from 10% to 50%.
- Type
- Chapter
- Information
- Emergency Management of Infectious Diseases , pp. 131 - 134Publisher: Cambridge University PressPrint publication year: 2008