DrVirgo
Forum Hero
Topics: 1082
Posts: 3,433
|
3-19
A 21 year old man comes to the ER after accidentally kicking a ladder in a swimming pool. The rail of the ladder was struck by his foot, between the first and second right toes. He is able to walk. Physical exam shows a lacerated wound which is approximately 4 cm long and 2cm deep in the first interdigital space. An x-ray film of the foot shows an oblique diaphyseal fracture of the second matatarsal bone with mild angular displacement and angle open laterally. No vessels, tendons, or nerves are damaged. Vital signs are stable. Which of the following is the most appropriate initial step in management?
A. Closure of the wound
B. Dressing of the wound
C. Closure of the wound and plaster cast
D. Dressing of the wound and plaster cast
E. Open reduction and closure of the wound
Please explain!
-when do we do closure vs dressing
-when do we do open reduction vs closed reduction
Thanks.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| madoo
Forum Newbie
Topics: 2
Posts: 32
|
seems too complicated for usmle
i think in such q they may ask about tetanus prophylaxis or gas gangrene
___________________
R U going to ?
|
| DrVirgo
Forum Hero
Topics: 1082
Posts: 3,433
|
This was a question in USMLE World so I suppose it's the type of question they could ask on the real exam.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| madoo
Forum Newbie
Topics: 2
Posts: 32
|
well if i had this q in exam i think i would say dressing of the wound as an initial step
B. Dressing of the wound
why ? because it is so important to delay the closure of an open fracture >A,C are wrong
D,E are definitive treatment options
plus this is how to manage an open fracture
Emergency management of open fractures :
ATLS resuscitation
Photograph
Wound swab
Remove gross contamination and apply moist sterile dressing (Betadine)
Antibiotics
Splint the limb
Check tetanus prophylaxis
Arrange for urgent surgical debridement/ washout and stabilization of the fracture
Conventional treatment advocates debridement and washout within 6-8 hours
http://www.rcsed.ac.uk/fellows/lvanrensburg/class...
___________________
R U going to ?
|
| DrVirgo
Forum Hero
Topics: 1082
Posts: 3,433
|
Answer is D.
This is considered an open fracture eventhough the bone is not protruding through the skin.
You are right: Open fractures should not be closed primarily because of the associated increased risk of infection adn subsequent osteomyelitis.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| madoo
Forum Newbie
Topics: 2
Posts: 32
|
don't know what to say
i did kaplan notes with Dr.pestana videos then bluepirnts and i thought i made surgery 
___________________
R U going to ?
|
| DrVirgo
Forum Hero
Topics: 1082
Posts: 3,433
|
Hey, you were right!
The only thing that was a bit confusing about this case was the fact that this was considered to be an open fracture eventhough he didn't have a bone sticking out through the skin, but because he had a lacerated wound.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| DrVirgo
Forum Hero
Topics: 1082
Posts: 3,433
|
by the way Kaplan says Open fractures are orthopedic emergencies and you should do reduction in the OR within 6 hours of injury.
So Fix, but delay closure? For how long?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| MAGY17
Forum Elite
Topics: 30
Posts: 234
|
good job
|
|
| |
| | | | | | | | | |
