First, a meticulous initial debridement to remove all contaminated and devitalized soft tissue and bone is performed. Then the extremity is reprepped and draped and new instruments are used to perform definitive stabilization of the fracture. The method of stabilization, i.e. intramedullary nails, plates, or a variety of external fixation devices, depends upon the fracture type and the location and extent of the soft tissue injury. Definitive wound coverage or closure, with local flaps and free tissue transfers, is performed within three to seven days of injury by the microsurgery team including Drs. John McFadden and David Tate.
Compartment syndrome can be a disasterous complication.
Constant awareness is paramount, and patients are monitored clinically for signs and symptoms of compartment syndrome. Any patient with suspected compartment syndrome is evaluated by use of the Stryker pressure monitor. Patients with pressures within thirty millimeters of their diastolic pressure require immediate decompressive fasciotomy. We are working with the radiology department on obtaining real time 3D images for pelvic and acetabular trauma. An acetabular surgery protocol standardizes our treatment of this complex injury.