Stable skeleton

The principles of skeletal fixation discussed above also apply in open wounds. In addition, optimum management of open fractures includes immediate intravenous broad-spectrum antibiotics and definitive fracture cleansing within four hours of injury. The extent of soft tissue injury in open phalangeal fractures has profound influence on expected outcome. Duncan (Duncan) evaluated open phalangeal fractures along the lines of the Gustilo classification as follows:

Using the criteria of total active motion for evaluation of outcome, Duncan found that three fourths of patients with a grade I injury and half of patients with a grade II injury had a good or excellent result. In contrast, almost all patients with a grade IIIB or IIIC injury had a poor result with less than 50 percent normal range of motion. For phalangeal fractures, periosteal stripping, either by injury or by the treating surgeon contribute strongly to a poor result.
e-Hand Previous Next Search Chapter Textbook