1. ORTHOPEDIC EMERGENCY

2. Trauma is the main cause of death Limb injuries predominate Head and visceral injuries the most lethal Trauma mortality has a trimodal distribution Most death occur during 1st hour after injury A second peak 1-4 hours after injury A third peak several weeks later

3. Remember • Airway • Breathing • Circulation

4. The exception to this is casualty suffering external, peripheral hemorrhage. Catastrophichemorrhage Airways Breathing Circulation Life threatening,external bleeding is controlled first and then followed by ABC sequence.

6. Wound should be covered with sterile dressing or clean material and left undisturbed until pt reach A&E

7. In hospital, rapid assessment and any life threatening condition are addressed

10. Grade I Wound: < 1cm Contamination: clean puncture Soft Tissue: little damage/ no crush Fracture: simple transverse/ oblique with minimal comminution Vascularity intact

11. Grade II Wound: > 1cm Contamination: moderate Soft Tissue: moderate Fracture: moderate comminution

12. Grade III Wound: extensive skin loss,more than 10cm Contamination: high degree Soft Tissue: extensive soft tissue damage Fracture: highly comminuted Includes: High velocity trauma Gunshot injuries Farmyard injuries Fractures requiring vascular repair

13. Grade IIIa Grade III with Sufficient tissue to allow bony cover.

14. Grade IIIb Grade III with Extensive soft-tissue damage with periosteal stripping and bone exposure. Inadequate soft tissue for bony cover.

15. Grade IIIc Any open fracture with vascular injury that requires repair (for survival of the limb). Associated arterial injury

16. Infection & Amputation Rates Gustilo Grade Infection Rate Amputation Rate I 0 – 2% - II 2 – 7% - IIIa 7% 2.5% IIIb 10 – 50% 5.6% IIIc 25 – 50% 25%

18. The 4 essential are: Prompt wound debridement Antibiotic prophylaxis Stabilization of fracture Early definitive wound cover

20. In most cases, a combination of benzyl penicillin and flucloxacillin are given 6 hourly for 48 hours.

22. Under general anaesthesia, clothing removed and maintain traction and hold it still

26. Wound then washed out with copious amount of saline

28. Dead tissue – purplish color, mushy consistency, fail to contract when stimulated, fail to bleed when cut

31. Type III wound may have to be debrided more than once.