EM Vivas · Limb and extremity trauma
Gustilo, hard signs and compartment viva
Data viva on Gustilo grading, antibiotic choices, vascular hard signs and compartment decision-making.
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Study tools
Target exams
ACEMFRCEMABEM
Prompt
Open tibial wound photo description + tense calf + Doppler reduced. Classify, antibiotics, theatre triggers.
Interpretation
Reveal interpretationShowHide
Classification. Contaminated open tibia with soft-tissue injury is Gustilo III; add C if vascular repair needed.[1]
Antibiotics. Early IV cefazolin; broaden for III/farm contamination; tetanus.[2]
Vascular. Reduced Doppler with cool foot is at least soft-to-hard spectrum — low threshold for theatre vs CTA based on hard signs and stability. [1]
Compartment. Tense calf + pain on stretch = clinical compartment syndrome → fasciotomy pathway, not observation for pulselessness. [1]
References2ShowHide
- [1]Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma, 1984.PMID 6471139
- [2]FLOW Investigators, Bhandari M, Jeray KJ, et al. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. N Engl J Med, 2015.PMID 26448371