Open fractures and Osteomyelitis (Shatavisa Manna 1626).pptx

Fracture on limbs

1. Open fractures & osteomyelitis Shatavisa Manna Group- 1626

2. Open fractures Open fractures are fractures where the broken bone communicates with the external environment through a skin wound. They pose a high risk of infection and complications due to contamination and soft tissue damage. Initially open fracture : The fracture has an open wound at the time of injury that communicates with the fracture site from the beginning. Secondarily open fracture : Initially a closed fracture that later becomes open due to skin breakdown, surgical intervention, or wound dehiscence.

3. localization Tibia (Shin): The tibia is the most commonly affected bone in open fractures due to its subcutaneous location and limited soft tissue coverage, making it highly susceptible to injury and infection.​ Open tibial shaft fractures are particularly at high risk for infection, delayed union, and nonunion compared to other locations.​ Distal and mid-shaft tibial fractures are the most frequently involved areas; the severity and rate of complications tend to be higher in these sites.​ Lower Extremity vs. Upper Extremity: Lower limb open fractures, especially those involving the tibia and foot, have significantly higher infection rates than upper extremity fractures due to poorer soft tissue protection, more contamination, and a greater likelihood of high-energy trauma.​ Lower extremity injuries often require more complex reconstructive procedures and soft tissue coverage. Other Sites: Open fractures can also occur in the femur, ankle, foot, forearm, hand, and pelvis.​ Upper extremity open fractures typically have better outcomes due to richer vascularity and more robust soft tissue coverage. 3

4. Gustilo-Anderson classification  4

5. Osteomyelitis is a bone infection caused by pyogenic microorganisms, most commonly  Staphylococcus aureus . It may occur through hematogenous spread, direct inoculation (as in open fractures or surgery), or contiguous spread from adjacent infected soft tissues. It can present as acute, subacute, or chronic disease depending on the duration and severity of infection. OSTEOMYELITIS 5

6. Cierny -Mader classification 6

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13. complications Infection: The most common and serious complication, can lead to chronic osteomyelitis. Nonunion: Failure of the bone to heal, often due to poor blood supply or infection. Compartment syndrome: Increased pressure in muscle compartments causing ischemia and tissue death, requiring urgent fasciotomy. Chronic osteomyelitis: Develops when infection becomes established in the bone, requiring prolonged treatment. Nerve and vascular damage: May lead to limb dysfunction or loss. 13

14. 14 Initial management: Early antibiotic administration: Prophylactic antibiotics should be given within the first hour of injury, typically first-generation cephalosporins for most open fractures. In more severe cases (e.g., Gustilo type III), broader spectrum antibiotics including coverage for gram-negative organisms may be indicated, but extended antibiotic courses beyond 24 hours are generally not recommended unless there are signs of infection. Management of traumatic osteomyelitis

15. Surgical Management Debridement: Complete removal of necrotic bone and soft tissue is essential to eradicate infection.​ Dead space management: Filling the cavity with antibiotic-loaded bone cement, biodegradable carriers, or bone grafts ( Masquelet technique) prevents recurrence.​ Reconstruction: Structural defects may be reconstructed using bone grafts, vascularized bone (e.g. fibula), or the Ilizarov bone transport technique.​ Removal of implants: Any foreign hardware is removed if infected unless crucial for stability.​ 20XX Sample Text 15

16. 16 Fracture stabilization: Internal fixation (plates, intramedullary nails) for stable fixation when soft tissue condition allows. External fixation, especially for severe or heavily contaminated injuries or when soft tissue reconstruction is needed.

17. 17 Soft tissue management: Early soft tissue coverage using techniques such as flaps or skin grafting to improve healing and reduce infection risk.

18. Antibiotic Therapy Culture-directed antibiotics are essential. Empirical wide-spectrum coverage against  S. aureus  (including MRSA) and gram-negative organisms is started until culture results return.​ Typical regimens: IV therapy for 4–6 weeks followed by oral antibiotics for several weeks more.​ Common agents include: Oxacillin or cefazolin (for MSSA) Vancomycin, daptomycin, or linezolid (for MRSA) Ciprofloxacin or cefepime plus aminoglycosides (for  Pseudomonas ) Antibiotic beads or cement spacers offer targeted local therapy.​ Adjunctive Therapies Hyperbaric oxygen therapy (HBOT): Enhances oxygenation, promotes angiogenesis, and potentiates leukocyte and antibiotic effects. It has an 81–85% remission rate in chronic refractory cases.​ Bioactive materials:  Cerament -G and bioactive glass S53P4 are modern materials combining bone grafting and local antibiotic delivery.​ Flap coverage: Soft tissue closure with muscle or microvascular free flaps improves local perfusion and healing 20XX Sample Text 18

19. Associated damages Nerve damage Traumatic nerve injury in open fractures occurs by direct laceration, contusion, traction, or compression within the zone of injury. This leads to motor and sensory deficits in the affected limb or region. Nerve injury may be partial or complete and involves common nerves near fracture sites (e.g., the radial nerve in humeral fractures, peroneal nerve in proximal tibia fractures). In osteomyelitis, ongoing inflammation and fibrosis can entrap nerves or cause neuropathy, compounding functional impairment. Surgical interventions for debridement or fixation can also risk iatrogenic nerve injury if not carefully performed. Blood vessels damage In open fractures, vascular injury can occur from the initial trauma causing vessel laceration, thrombosis, intimal injury, or spasm. This leads to compromised limb perfusion and, if untreated, ischemia and tissue necrosis. Gustilo type IIIC open fractures are characterized by an arterial injury requiring surgical repair for limb salvage. Vascular damage can result in compartment syndrome due to reperfusion injury or hemorrhage. In osteomyelitis, chronic infection and inflammation can cause endarteritis obliterans, fibrosis, and thrombosis of bone-feeding vessels, worsening bone ischemia and necrosis. Impaired blood flow limits antibiotic delivery and immune response, perpetuating chronic infection. 20XX 19

20. Thank you Shatavisa manna group- 1626 20