The main objective is to restore the function of the extremity of pain. This depends on the rapid healing of wounds, with the recovery and software network union (fusion) fracture and restoration in accordance with the anatomical location. It is also important to prevent complications (Armis, 2001).
Fracture action on the open must be made as soon as possible. Delay time can lead to complications of infection. The optimal time to act before the 6-7 hour (golden period). Give toksoid, anti-tetanus serum (ATS), or human tetanus globulin. Give antibiotics for Gram-positive bacteria, and negative with a high dose. Make checks culture and resistance from the germs basic fracture open wound (Mansjoer et al., 2000).
Assessment and management is conducted in the emergency unit aims to:
1. First before handling definitive.
2. Resuscitate. Lost a lot of blood on the fracture open resuscitate necessary action.
3. Initial assessment (preliminary assessment). A thorough examination and careful observation is the basis in the patient.
4. Debrideman
Technical debrideman according Mansjoer et al. (2000) is as follows:
a. Perform general narcosis or local anesthesia and light injuries when small.
b. When the injury is quite broad, post tourniquet first (pump or Esmarch)
c. Wash the entire extremity for 5-10 minutes and then do the shearing. irrigated wound with sterile NaCl solution or water 5-10 minutes.
d. Perform decontamination measures and the kerchief.
e. Eksisi wound layer for layer, from the skin, subkutis, fascia and muscle. Eksisi musculature that is not vital. Discard bones, small bones that are not attached to the periosteum. melestarikan large bone fragment that is necessary to stability.
f. Fracture always open wound is left open and when it closed a week after the edema disappeared and the (secondary suture) or it can also be sewn only situation when the injury is not too wide (rarely injured sewing).
5. Antibiotic therapy.
Giving antibiotics immediately after true diagnosis. Ideally a high dose of broad spectrum antibiotics such as benzylpenicillin 1 mega units every 6 hours plus flucloxacillin 500 mg every 6 hours. If the wound is very dirty need additional attention to gentamicin in addition to kidney function. Clinical treatment is done to wound is not infected. The provision of anti-tetanus should be careful. Now widely used tetanus immunoglobulin (human) in patients who had not got immunization. And also have to give tetanus booster toksoid. Debrideman and antibiotics can prevent adequate gas gangrene (Armis, 1994).
Cefazolin is an antibiotic that adequate to open fracture type I and II. If wound contamination there is a heavy (fracture open type III), aminoglikosida can be added (eg gentamicin or tobramicin). When therapy is required then profilaksi penicillin may be added. Profilaksi and tetanus immunization should be given to patients who have not been immunized (Arneja & Buckley, 2004).
Fracture is open emergency to do the operation. Objective is to clean wounds, remove the network contaminated and death and a foreign object. Penetrating injury (simple puncture) is cleaned and sewed, but the wound is large and needs to be done contaminated toilet and wound exploration. If the wound needs to be dilated, all of the network is broken and discarded dead. Leave the wound is open. Cleaning should be wound with a physiological fluid or liquid detergent and remove foreign substances that enter into the wound. Network irrespective of the bones are removed and die, but the fragments of bone that should not. Vena vital need to immediately go through life member distal movement of the fracture. Nerve can be abandoned and in-repair operation on the next (secundere repair) who have previously given the identification (Armis, 1994).
The problem fixation on the Internal fracture with contamination in general is contraindicate. However, after fixation Internal installation wound healed and no more infection. Fracture degrees on the open and sometimes I degree II Internal fixation can be done. In the case of severe damage to the network that require action, then arterial repair Internal fixation is installed for the indication (Armis 1994).
Usage eksterna fixation (external fixation devices), only the fracture III opens with a degree fiksasi fragment-fragment fracture and simplify wound care (Armis, 1994).
Wound treatment during 7-10 days. On the plaster cast made hole (window) in order to clean the wound every day. If the wound has healed the treatment on bone fracture as fracture closed. Complications can cause osteomyelitis continuation fracture such as delayed union and non union (Armis, 1994).
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