Wound Management – Open Fracture

FRCEM EXAM QuestionsCategory: December 2016Wound Management – Open Fracture
FRCEM Intermediate Staff asked 2 years ago
A 30 year-old-man-patient presented with wrist wound after 12 hours, image done and shown below:


A.What is your immediate action? (1mark)
B.What features from (History and Examination) indicates prone wound? (1mark)
C.What intervention will you do to decrease risk of tetanus? (1mark)

1 Answers
FRCEM Intermediate Staff answered 2 years ago
A.

  • Control hemorrhage if bleeding e.g. direct pressure
  • Give Adequate Analgesia
  • Assess neurovascular status – Reduce gross deformities using gentle traction and splint the injured limb especially  if there is a neurovascular compromise
  • Wound assessment – Examine the wound, surrounding tissue, for any foreign body, contamination, and damage to the underlying structure-clean by profusely irrigating with saline – Apply dressing
  • Give antibiotics

B.

  • wounds or burns delayed more than 6 hours that need surgical intervention
  • wounds or burns with a significant degree of devitalized tissue
  • compound fractures

C.

  • Remove gross contaminants from the wound – clean by profusely irrigating with saline/remove foreign body
  • Tetanus toxoid in one arm I. M plus Tetanus human immunoglobulin 250-500 I.U in the other arm I. M