Klasyfikacja złamań otwartych
Leczenie ran Newsy Pod sliderem Rodzaje ran Złamania

Klasyfikacja złamań otwartych

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Oprócz podziału złamań na wysoko i niskoenergetyczne, urazowe, patologiczne niezwykle ważnym podziałem złamań kości i zwichnięć stawów jest podział na urazy zamknięte i otwarte. Leczenie będzie wówczas uzależnione od stopnia rozległości uszkodzenia tkanek miękkich i stopnia złożoności uszkodzenia.

Przydatnym i zarazem podstawowym czynnikiem w ocenie złamań będzie podział złamań otwartych wg. Gustilo-Andersona. Zgodnie z nim wyróżnia się trzy stopnie złamań:

I stopień charakteryzuje się niezakontaminowaną raną urazową, nie przekraczającą 1 cm. Tego rodzaju złamania otwarte powstają w wyniku przebicia skóry od wewnątrz ostrym odłamkiem kości i nie dochodzi podczas nich do uszkodzenia głębokich tkanek miękkich. Ich leczenie nie różni się od postępowania terapeutycznego przy złamaniach zamkniętych.

II stopień złamania otwartego wyróżnia skontaminowana rana, której długość wynosi do 10 cm. Tego typu rany powstają w wyniku działania czynników zewnętrznych na kość i tkanki miękkie. Przy tym stopniu złamania dochodzi do niewielkiego uszkodzenia głębokich tkanek miękkich.

III A stopień złamania otwartego charakteryzuje się długością przekraczającą 10 cm. Tego rodzaju ranę można zamknąć bez plastyki skóry i zazwyczaj powstają przez działanie czynników zewnętrznych na kość i tkanki miękkie. Uszkodzone zostają wówczas głębokie tkanki miękkie.

III B to stopień rany pourazowej, podczas którego dochodzi do znacznej kontaminacji rany, powstałej przez działanie czynników zewnętrznych na kość i tkanki miękkie. Uszkodzone zostają wówczas głębokie tkanki miękkie. Dochodzi również do ubytków tkanki miękkiej i złuszczenia okostnej. Tego rodzaju złamanie przekracza 10 cm. Ze względu na brak skóry i ubytek znajdujących się pod nią tkanek miękkich, jego leczenie nie obędzie się bez plastyki skóry.

III C charakteryzuje się uszkodzeniem głównego pęczka naczyniowego, podczas którego niezbędna będzie opieka chirurgiczna. Tego rodzaju rana jest raną pourazową o znacznym stopniu kontaminacji. Powstaje na skutek działania czynników zewnętrznych na kość i tkanki miękkie. Podczas tego stopnia złamania, dochodzi do uszkodzenia głębokich tkanek miękkich, a dokładniej ubytków tkanki miękkiej oraz złuszczenia okostnej. Zazwyczaj mierzy ok. 10 cm, dlatego aby możliwe było jej zamknięcie, niezbędna będzie plastyka skóry.

W przypadku złamań otwartych właściwym leczeniem będzie leczenie operacyjne. Przy złamaniach otwartych III stopnia, szczególnie III C niezbędne będzie leczenie wielospecjalistyczne, a rokowania dotyczące uratowania kończyny są zazwyczaj niemożliwe do pewnego określenia.

Standard postępowania w przypadku złamań otwartych

W przypadku złamań otwartych standardem postępowania będą takie czynności jak:

  • szybkie zaopatrzenie rany,
  • obfite płukanie złamania,
  • antybiotykoterapia,
  • niekiedy również terapia w komorze hiperbarycznej.

Źródło: Głuszek S., Chirurgia Podstawy, Wydanie II uaktualnione i rozszerzone Warszawa 2019, s. 43-44

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