1. OPEN (COMPOUND) FRACTURES

3. An open fracture can be defined as a broken bone that is in communication through the skin with the environment.

4. Open fractures are much like pregnancy: they either are or they are not.

6. THE INCIDENCE OF OPEN FRACTURES: AN ANALYSIS OF 960 FRACTURES OVER A 6-YEAR PERIOD (Edinburgh, Scotland)

7. Gustilo type IIIB open fracture. Angiographic evidence of vascular injury after traumatic injury

8. PRINCIPLES OF TREATMENT 1. Open injuries to bones and joints should be treated as emergencies. 2. The patient should be evaluated carefully to diagnose other life-threatening injuries. 3. Appropriate and adequate systemic antibiotic therapy should begin immediately. 4. The wound should be thoroughly debrided and cleansed. 5. The fracture or joint injury should be stabilized; cancellous bone grafting can be performed immediately or can be delayed. 6. The wound should be appropriately dressed or closed; measures should be taken to facilitate wound drainage. 7. The limb and patient should undergo rehabilitation.

9. Skeletal traction with a Steinmann pin in the distal femur for management of a femur fracture.

12. OSTEOMYELITIS

13. OSTEOMYELITIS IS AN INFECTION OF BONE, BONE MARROW AND SURROUNDED SOFT TISSUES

14. Cause  S. Aureus S. Aureus  Enterobacter Enterobacter  Streptococcus Streptococcus

15. Pathogenesis Microorganisms may infect bone through one or more of three basic methods: via the bloodstream, contiguously from local areas of infection (as in cellulitis),bloodstream cellulitis penetrating trauma, including iatrogenic causes such as joint replacements or internal fixation of fracturestraumaiatrogenicjoint replacements fractures root-canaled teeth root-canaled

16. Areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis.acutechronic

18. A SEQUESTRUM is a piece of dead bone that has become separated during the process of necrosis from bone.

19. Sequestrum Types a)Cortical; б)Central; в)Penetrable;г)Total

20. Clinical exam

22. cutaneous fistula

23. Diagnosis (X-ray) Diagnosis of osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis. radiologiclyticsclerosis

24. Diagnosis (X-ray)

25. Diagnosis (CT)

26. Diagnosis (Scintiography)

27. Treatment surgical debridement.debridement immobilization prolonged antibiotic therapyantibiotic hyperbaric oxygen therapy hyperbaric oxygen therapy enhancing of immunity status

28. Treatment (fistulo-sequestr-necrectomia) A SEQUESTRUM is a piece of dead bone that has become separated during the process of necrosis from bone. It is a complication (sequelae) of osteomyelitis.

29. Surgical debridement

30. Preparing to the operation

31. Surgical debridement (technique)

32. Drainage (passive)

33. Drainage (active)

34. IMMOBILIZATION

44. FILM BULLET

45. ALL GUNSHOT WOUNDS ARE PRIMERILY CONTAMINATED

46. MICROORGANISM INVASION Time INFECTION

47. GENERAL PRINCIPLES OF OSTOMYELITIS PREVENTION  BANDAGE

48. GENERAL PRINCIPLES OF OSTOMYELITIS PREVENTION  Splintage, antibiotics per os.

49. GENERAL PRINCIPLES OF OSTOMYELITIS PREVENTION  QUICK EVACUATION TO HOSPITAL

50. GENERAL PRINCIPLES OF OSTOMYELITIS PREVENTION URGENT SURGEORY

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52. QUESTIONS ?