Limb Trauma

• A multidisciplinary team, including orthopaedic and plastic surgeons with appropriate experience, is required for the treatment of complex open fractures.
• Hospitals which lack a team with requisite expertise to treat complex open fractures should have arrangements for immediate referral to the nearest specialist centre.
• The primary surgical treatment (wound debridement/excision and skeletal stabilisation) of these complex injuries takes place at the specialist centre whenever possible.
• Specialist centres for the management of severe open fractures are organised on a regional basis as part of a regional trauma system. Usually these centres also provide the regional service for major trauma.

Primary management in the emergency department

• Initial assessment and treatment of the patient occurs simultaneously and in accordance with Advanced Trauma Life Support (ATLS^®) principles.
• Assessment of the open tibial injury is systematic, careful and repeated in order to identify established or evolving limb-threatening conditions and to document limb status prior to manipulation or surgery.
• Haemorrhage control is through direct pressure or, as a last resort, application of a tourniquet.
• Wounds are handled  to
• Remove gross contaminants
• Photograph for record
• Seal from the environment
  • Limb splintage is the most appropriate means of immobilisation available in the Emergency Department. Provisional external fixators are not applied.
  • Antibiotic and anti-tetanus prophylaxis is given.
  • Multiple X Rays are taken to assess the exact nature of the injury