July 14, 2013

Image of the Day 19: Open Fracture of Right Distal Third Femur

24 years old gentleman alleged fall from his motorbike at high speed after a lorry try to over take him. He sustains open fracture of his right femur and open fracture of the right radius/ulna.

Upon presentation, patient was conscious and alert, tachycardic, pallor, and in great pain with score of 9/10. Blood pressure however remain normotensive.

He was managed in red zone with high flow mask 10L/min, vital sign and cardiac monitoring, two large bore IV line and given fluid resuscitation. For the pain management, he was given IV Fentanyl 100 mcg stat followed by femoral block prior to an attempt to reduce and align the fractured bone. However, due to the long duration of injury together with tense muscle spasm, the attempt was unsuccessful and he was sent for emergency operation for wound irrigation and external fixator application. 


  1. bro how do grade tis #,, is this gustilo 3C but is there any vascular injury,moreover pt is normotensive but yeah tachycardic is better indicator of blood loss or this is grade 3B... n what a/b has been started, do we start 3 a/b in these case for e.g cefuroxime(broad spec),genta, flagyl ..???? saja tanya nak buleh ilmu sikit....

  2. Actually The best time to assess the grading of open fracture is on table while doing the debridement and external fixator... from our emergency site, we just comment it as a open fracture gustilo 3.. whether it's a, b, or c is hard to tell.. but of course to access the vessel status, you can use doppler to check for the distal pulse..

    this injury is either 3B or 3C... but our assessment for vascular status is intact... i'm not sure regarding on table finding by ortho team..

    regarding antibiotic.. class I evidence said all open fracture should be covered with antibiotic against gram positive and if open grade three, then add antibiotic to cover for gram negative... class II evidence said can cover with aminoglycoside alone...


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