Brown C, Henderson S, Moore S
Washington University School of Medicine, Barnes Hospital, St Louis, USA.
AORN J. 1996 May;63(5):875-81, 885-96; quiz 899-906. doi: 10.1016/s0001-2092(06)63100-1.
Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitis, which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm accidents, falls from heights, or gunshot wounds. Initial management of patients with multiple trauma injuries focuses on their life-threatening injuries before or during orthopedic surgical intervention for open tibial fractures. Orthopedic surgeons often work in collaboration with general, vascular, and plastic surgeons and perform multiple surgical procedures (eg, fasciotomy procedures for compartment syndromes, irrigation and debridement of wounds, application of external fixation devices, placement of intramedullary nails, possible limb amputations). The type and extent of open tibial fractures and soft tissue injuries determine the best treatment options for patients. Perioperative nurses should help patients focus on treatment choices for their open tibial fractures that ensure optimal surgical outcomes and maintain their quality of life.
开放性胫骨骨折是真正的外科急症，因为存在骨和失活软组织发生广泛感染的风险。开放性胫骨骨折最严重的后果是骨髓炎，通常可通过在受伤后六至八小时内迅速进行手术干预来预防。开放性胫骨骨折常由机动车碰撞、农场事故、高处坠落或枪伤等外伤引起。多发创伤患者的初始治疗重点是在对开放性胫骨骨折进行骨科手术干预之前或期间处理危及生命的损伤。骨科医生常与普通外科医生、血管外科医生和整形外科医生合作，进行多种外科手术（如针对骨筋膜室综合征的筋膜切开术、伤口冲洗和清创、应用外固定装置、置入髓内钉、可能的截肢手术）。开放性胫骨骨折的类型和程度以及软组织损伤情况决定了患者的最佳治疗方案。围手术期护士应帮助患者关注其开放性胫骨骨折的治疗选择以确保获得最佳手术效果并维持其生活质量。
