FRACTURAS EXPUESTAS

FRACTURAS EXPUESTAS

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Fracturas expuestas

Es la comunicac comunicación ión de los fragmentos óseos de un fractura fractura o de su hema hematoma toma con con el medio externo, con con la existencia de lesiones

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HISTORIA 

Hipócrates puso en duda la idea de que la enfermedad era un castigo enviado por Dios  y descubrió la relación

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Principio básico de Hipócrates, se centra en el poder de cicatrización de la naturaleza, en las fracturas abiertas utilizó cinco medidas de tratamiento:

 Antisepsia

 Vendaje  V endaje

Reducción

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Historia En el Renacimiento Renacimie nto se lograron pocos progresos en cirugía.

Galeno afirmo afirmo que la cocción cocción o supuración era fundamental para la cicatrización de la herida. Teodorico de Salerno

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Ambrosio Paré…

Hizo ligaduras de grandes vasos en las amputaciones . Propuso el lavado de heridas, que difiere del método clásico.

``Uno de los principales medios   para curar curar heridas es conservarlas  conservarlas 

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En el siglo XV Leonardo Leo nardo da Vinci proporciono un empuje al desarrollo de las habilidades

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 Joseph Lister(1867), Lister(1867), publico 11 casos de fracturas abiertas

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Durante la primera guerra mundial  Winnette  Winnette Orr, Orr, tuvo que tratar las

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Criterios para el tratamiento de fracturas expuestas según Dr. Orr Desbridamiento Desbrida miento primario completo.

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Dr. Hampton … Durante la segunda guerra mundial utilizo util izo el método de fijación interna diferida. Esquematizó Esquemat izó la ventajas y desventajas de la fijación fi jación interna: 

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

Gustilo y Anderson…

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Rie

de Infección Infección

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III A : Hueso fracturado con cobertura cobertura adecuada de partes blandas “Cobertura de hueso con periostio”. Incluye fracturas segmentarias o con conminucion severa

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III B: Lesión extensa de partes blandas con “Perdida del periostio” y gran exposición ósea, se asocia a contaminación masiva.

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Caudle y Stern : Grado III B

logra una cobertura cobertura adecuada dentro de la III B 1: Se logra primera semana de evolución.

III B 2: No se logra una cobertura adecuada dentro de la primera semana de evolución.

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III C: Fractura expuesta asociada con lesión arterial que requiere reparación o amputación. Frecuencia de amputaciones amputaciones IIIc 25  – 90% .

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

D: amputación traumática

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Fracturas Expuestas Tipo

Mecanismo

Herida

Compromiso de partes blandas

Fractura

Nivel de contaminación

I

Baja energía

≤ 1 cm,

Escaso

Rasgo

Bajo

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FRACTURAS EXPUESTAS QUE SE CONSIDERAN Grado III Fx. Segmentaria



Lesiones por accidentes agrícolas



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Diagnostico

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PROCEDIMIENTOS Y EXAMENES A

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Estabilización de la

fractura



Preservar la integridad de los tejidos blandos, músculos y estructuras neurovasculares neu rovasculares que permanecen viables.

 

Facilitar el cuidado de la herida h erida Proporcionar al paciente comodidad durante su movilización

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Considerar: Magnitud Perdida

de la herida

de la piel

Riesgo de infección Lesiones asociadas

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a a e conso ac n e una fractura infectada “ El hecho es que la infección no es causa de falta de consolidación. Si se produce falta de consolidación, esta no es debida a la infección, in fección, sino a la inmovilización inadecuada, que es causada por la infección. “ Sir Reginald Watson Jones

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ESTABILIZACI EST ABILIZACION ON RIGIDA 1. Promueve unión ósea de la fractura. 2. Facilita el manejo de los tejidos blandos. blando s. 3. Efecto profiláctico profiláct ico sobre la infección.

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Estabilizadores: Estabilizadores:

•

Osteosíntesis Osteosíntesis

•

Fijadores Fijadores Externos Externos

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Osteosintesis

Traumatismos múltiples

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Osteosintesis 

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Fijación Externa 

Se usan en fracturas

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Fijación Externa 

Fijación Externa  Ventajas  V entajas

Colocación lejos del sitio de

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Tracción Esquelética

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Pensar es el trabajo más difícil que existe. Quizá esa sea la razón por la que haya tan pocas personas que lo practiquen . Henry Ford (1863-1947) Industrial estadounidense 

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