Overview
Clinical Meaning
The nurse managing fractures must understand the Gustilo Anderson open fracture classification, compartment syndrome pathophysiology and management, and fracture specific compli...
The nurse managing fractures must understand the Gustilo-Anderson open fracture classification, compartment syndrome pathophysiology and management, and fracture-specific complications. The Gustilo-Anderson classification grades open fractures: Type I (wound less than 1 cm, minimal contamination, simple fracture pattern); Type II (wound 1-10 cm, moderate soft tissue damage, no flap or avulsion); Type IIIA (wound greater than 10 cm, high-energy, adequate soft tissue coverage after debridement); Type IIIB (extensive soft tissue loss requiring flap coverage); Type IIIC (any open fracture with arterial injury requiring repair). This classification guides antibiotic selection and surgical timing. Compartment syndrome occurs when pressure within a fascial compartment exceeds capillary perfusion pressure (normally 30-40 mmHg), compromising blood flow to muscles and nerves within the compartment. The anterior compartment of the leg (from tibial shaft fractures) and the volar compartment of the forearm (from forearm fractures) are most commonly affected. Compartment pressure measurement above 30 mmHg or within 30 mmHg of diastolic BP (delta pressure) is diagnostic. Treatment is emergent fasciotomy (surgical opening of the fascial compartments). Delay beyond 6 hours results in irreversible muscle necrosis (Volkmann ischemic contracture...
