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Open Fractures Management
Posted: May 15 2020 #(C101460)
A

Lawnmower Injury in 8-year-old male

HPI

Patient brought in by father who accidentally ran over son's foot with riding lawnmover.

PMH

None, otherwise healthy Tetanus up to date, NKDA

PE

L foot - full-thickness laceration through 1st webspace to level of the midfoot, gross contamination with grass and dirt, dorsalis pedis absent, strong posterior tibial pulse, grossly sensate over medial and lateral aspects of plantar foot, capillary refill intact to 2nd - 5th toes

Poll
1 of 12
1. Would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
30%
869/2824
Yes - additional radiographic views
17%
493/2824
Yes - CT scan of the foot
26%
735/2824
Yes - MRI of the foot
1%
51/2824
Yes - CT scan + additional radiographic views
14%
404/2824
Yes - MRI + additional radiographic views
1%
45/2824
Yes - MRI + CT scan + additional radiographic views
2%
78/2824
Outside my area of expertise - best if I don't vote
5%
149/2824
2. How would you classify this injury?
I would not classify this injury
3%
97/2713
Gustilo-Anderson type I
0%
5/2713
Gustilo-Anderson type II
3%
105/2713
Gustilo-Anderson type III
84%
2301/2713
Outside my area of expertise - best if I don't vote
7%
205/2713
3. How soon would you initiate IV antibiotics after arrival?
I would not initiate any IV antibiotics
0%
9/2725
Immediately
88%
2415/2725
Within 1 hour
6%
179/2725
Within 2 hours
0%
15/2725
Within 4 hours
0%
15/2725
Within 6 hours
1%
31/2725
Within 12 hours
0%
1/2725
Within 24 hours
0%
7/2725
>24 hours after arrival
0%
0/2725
Outside my area of expertise - best if I don't vote
1%
53/2725
4. What IV antibiotics would you initiate upon arrival?
I would not initiate any IV antibiotics
0%
2/2700
Cephalosporin (Ancef) only
7%
204/2700
Penicillin (G) only
1%
28/2700
Aminoglycoside (Gentamycin) only
0%
7/2700
Cephalosporin (Ancef) + Pencillin (G)
6%
185/2700
Cephalosporin (Ancef) + Aminoglycoside (Gentamycin)
33%
893/2700
Cephalosporin (Ancef) + Aminoglycoside (Gentamycin) + Pencillin (G)
45%
1241/2700
Other
1%
45/2700
Outside my area of expertise - best if I don't vote
3%
95/2700
5. How would you manage this injury?
Nonoperative
0%
7/2645
Operative
98%
2611/2645
Outside my area of expertise - best if I don't vote
1%
27/2645
6. If you choose Operative management, when would you take this patient to the OR?
I would not choose Operative management
0%
0/2653
Immediately
67%
1790/2653
Within 6 hours
23%
615/2653
Within 12 hours
2%
77/2653
Within 24 hours
3%
100/2653
Within 48 hours
0%
13/2653
>48 hours
0%
10/2653
Outside my area of expertise - best if I don't vote
1%
48/2653
7. If you choose Operative management and performed Debridement and Irrigation (in addition to other procedures), what type of irrigant would you use?
I would not choose Operative management
0%
0/2586
Saline
66%
1719/2586
Saline + Castile soap
17%
457/2586
Antibiotic solution
10%
283/2586
Other
1%
39/2586
Outside my area of expertise - best if I don't vote
3%
88/2586
8. If you choose Operative management, in addition to Debridement and Irrigation, what would be your plan going into surgery?
I would not choose Operative management
0%
4/2532
External fixation only
11%
293/2532
Closed/Open reduction Percutaneous pinning (CR/ORPP) only
43%
1113/2532
Open reduction internal fixation (ORIF) only
4%
102/2532
External fixation + CR/ORPP
22%
558/2532
ORIF + CR/ORPP
10%
263/2532
Amputation
1%
28/2532
Outside my area of expertise - best if I don't vote
6%
171/2532
9. If you choose Operative management, and primary wound closure was NOT possible at the initial surgery, would you apply negative pressure wound therapy (wound VAC)?
I would not choose Operative management
0%
7/2462
No
16%
394/2462
Yes
79%
1956/2462
Outside my area of expertise - best if I don't vote
4%
105/2462
10. If you choose Operative management, and primary wound closure was NOT possible at the initial surgery, when would you aim to perform definitive soft tissue coverage?
I would not choose Operative management
0%
0/2402
Within 24 hours
3%
89/2402
Within 48 hours
12%
298/2402
Within 72 hours
25%
602/2402
Within 5 days
14%
352/2402
Within 7 days
22%
531/2402
Within 2 weeks
12%
299/2402
> 2 weeks
3%
87/2402
Outside my area of expertise - best if I don't vote
5%
144/2402
11. If you choose Closed/Open reduction Percutaneous pinning (CR/ORPP) with construct seen in x-rays below, when would you remove the pins?
I would not choose Operative management
0%
2/2277
at ~2 weeks
2%
48/2277
at ~4 weeks
24%
561/2277
at ~6 weeks
49%
1127/2277
at ~8 weeks
13%
297/2277
at ~12 weeks
4%
97/2277
at >12 weeks
1%
30/2277
Outside my area of expertise - best if I don't vote
5%
115/2277
12. If you choose Closed/Open reduction Percutaneous pinning (CR/ORPP) with construct seen in x-rays below, when would you allow weight-bearing?
I would not choose Operative management
0%
0/2295
Immediately
0%
14/2295
at ~<4 weeks
3%
84/2295
at ~6 weeks
29%
681/2295
at ~8 weeks
30%
694/2295
at ~12 weeks
23%
550/2295
at >12 weeks
6%
160/2295
Outside my area of expertise - best if I don't vote
4%
112/2295
PROCEDURE #1 DOP: 3/1/2019

Debridement and irrigation (11044); Open reduction and percutaneous pinning of multiple metatarsal fractures (28485); Open reduction and percutaneous pinning of tarsometatarsal fractures (28606); Application of negative pressure wound therapy (97605)

Intra-procedure P1
PROCEDURE #2 DOP: 3/3/2019

Debridement and irrigation (11044) with delayed primary closure (13160)

Intra-procedure P2
icon
OUTCOMES
3 months after
Post-procedure P2
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