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Orthopaedics
Open Fractures
Built from Orthopedic Trauma Essentials
What’s inside
7 sections · 80 slides
Overview
- Four questions this topic answers
What an open fracture is
Why a broken bone that reaches the outside world is a different problem
- A broken bone that meets the outside world
- The two complications everything is aimed at
- A broken tibia seen on X-ray
- How severity is graded
- The severity ladder, step by step
- Debridement: the operation that decides the outcome
Timing of surgical debridement
Is the traditional 6-hour rule still supported?
- Where the 6-hour rule came from
- What replaced the single deadline
- The 6-hour rule tested in open tibial fractures
- Why that result cannot be read alone
- A second, larger pooled analysis
- The same blind spot, stated plainly
- A confounder, in one line
- GOLIATH: delay does matter after all
- Reading an odds ratio without maths
- GOLIATH: the numbers by injury type
- What GOLIATH concluded
- Old rule versus current reading
- A fourth review, and what it added
- What those authors said matters more than the clock
- Injuries that still go to theatre immediately
- The conditions that make a longer window safe
- Timing: the bottom line
Antibiotic prophylaxis
Which drug, how soon, and for how long, graded by injury severity
- The one intervention that consistently works
- Three things that decide whether it works
- Prevention must be stratified, not standardised
- The foundational cohort study
- The same 3-hour signal in severe tibial injuries
- From injury to first dose
- Which organisms, in the milder grades
- Which organisms, in type III injuries
- Choosing cover by grade
- How long: the randomised answer
- What the consensus groups settled on
- Why a longer course is actively worse
- Dirty wounds need one more drug
- The problem with aminoglycosides
- What contemporary consensus asks for instead
- Antibiotics: the bottom line
- How to read the antibiotic table
- Summary of evidence-based antibiotic strategy by fracture severity
Closing the wound
Early cover or delayed cover in type III open fractures
- Why closure strategy is not a detail
- The old habit and the challenge to it
- Godina's landmark observation
- What Godina's study set up
- Fix and flap
- The fix-and-flap sequence
- Where this care should happen
- Fix does not have to mean a nail on day one
- Holding the bone from outside the limb
- Rebuilding bone that has been lost
- A ring frame on the lower leg
- The same frame seen on X-ray
- Definitive metalwork inside the tibia
- When early closure is the wrong choice
- Closure: the bottom line
Negative pressure wound therapy
A widely used dressing that high-quality evidence has not confirmed
- Suction on a wound: what it is
- Foam dressing cut to the shape of the wound
- Sealed film and suction pad on a limb
- The pump and collection canister
- 5.4%
- What Stannard's study actually was
- What the pooled analyses report
- The Cochrane verdict
- WOLLF: the trial that settled the question
- What WOLLF found
- Early promise versus later trials
- NPWT: the bottom line
Pulling it together
What actually changes the outcome in an open fracture
- What actually changes the outcome
- Four answers in four lines
- Traps to avoid in exams and on the ward
- Where the evidence is still thin
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- Orthopedic Trauma Essentials 2026