Recalling Kevin Ware’s injury from the 2013 Elite Eight game (Louisville vs. Duke) began a discussion on open fractures last week. Now that we are a week into March Madness and that much closer to the Final Four, a good number of us are probably mildly depressed about our brackets. I must apologize to those people because this is not a terribly uplifting blog.
While I stressed the importance of immediate ER care last week, now I will expand on what exactly you can expect when you get there. Your podiatrist at Advanced Foot Care will evaluate you as a whole first. Airway, breathing, circulation, and cognitive deficits consistent with head trauma are the most important factors to assess. It is also important to know your tetanus status so your physicians can give you any boosters if necessary.
Infection is a great concern because your bone and soft tissue, which has never seen the light of day, becomes exposed to all the nasty organisms that live everywhere from the air we breathe to our very own skin. Therefore, the next step your doctor takes is to irrigate the wound and debride unsalvageable tissue. This wards off the germs and exposes the wound to oxygen, respectively.
Your doctor will also start you on antibiotics to prevent infection. You will likely be given a broad spectrum antibiotic since it is impossible to know what organisms have colonized the wound. Generally, 24-72 hours of this therapy does the trick. Your podiatrist or orthopedic surgeon may opt to insert a pouch of antibiotic beads directly into the wound itself. This allows greater penetration of the drug to the site of injury without systemic side effects.
Lastly, your foot and ankle surgeon will set the fracture and decide if emergent surgery is necessary or not. Surgical treatment of open fractures could fill 20 blogs, but I will summarize the main points in my blog next week as I conclude this blog series on open fractures.
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