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Management of open fractures: part 1

机译：开放性骨折的处理：第1部分

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摘要

Open fractures have been considered one of the true orthopaedic emergencies by some, however optimal treatment has not been definitively described. Significant debate has focused on the most appropriate method by which to manage open fractures, but general principles of treatment are well established. Principles include fracture classification, antibiosis, irrigation, debridement, wound management and fracture stabilisation. In this first of a two-part series on open fracture management, the initialmanagement of the patient, which should be performed within the first few hours after presentation, is discussed. This includes assessment and stabilisation of the patient, classification of the fracture, antibiotic use and irrigation of the wound. Openfracture classification systems, such as the Gustilo-Anderson scheme, are used to describe the relationship and degree of soft tissue damage, and are designed to correlate with treatment guidelines and prognosis. Systemic antibiotics are a required component of successful treatment, and prompt initiation of these is important. Irrigation is a key component of the effort to prevent infection, and this should be performed using saline solution and low-pressure methods routinely. The remaining principles (debridement, wound management andfracture stabilisation) will be explored in the second article in this series.
机译：某些人已将开放性骨折视为真正的整形外科急症之一，但尚未明确描述最佳治疗方法。大量的辩论集中在处理开放性骨折的最合适方法上，但是已经确立了一般的治疗原则。原则包括骨折分类，抗菌，冲洗，清创，伤口处理和骨折稳定。在由开放式骨折治疗分为两部分的第一个系列中，讨论了应该在就诊后的最初几个小时内对患者进行的初始管理。这包括评估和稳定患者，骨折的分类，抗生素的使用和伤口冲洗。开放性骨折分类系统（例如Gustilo-Anderson方案）用于描述软组织损伤的关系和程度，并旨在与治疗指南和预后相关。全身性抗生素是成功治疗的必要组成部分，因此迅速开始治疗很重要。灌溉是预防感染的关键因素，应定期使用盐溶液和低压方法进行灌溉。其余原则（清创，伤口处理和骨折稳定）将在本系列的第二篇文章中探讨。

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