- Q: Talk a little bit about what would constitute as an orthopaedic emergency and would lead to a surgery immediately?
- Leslie Barnes Remski, M.D.: Well from my perspective, anything that requires urgent surgery (open fracture is the most common of these injuries) where there's an open wound associated with a fracture or an open joint. In those cases, the risk of infection and other complications is increased if it isn't treated very quickly. The fracture itself very commonly is not the urgency, it's really that it's an open fracture. So the most important thing in those cases is that antibiotics are given first. It doesn't mean that you'll go to surgery immediately, but antibiotics need to be administered. The wound needs to be protected and the bone stabilized. And then an orthopedic surgeon will typically see you within a very short amount of time and make plans for what needs to be done next. Hand fractures are the only area where you can have an open wound. Antibiotics again are the number one treatment, but then you don't necessarily need to see an orthopedic surgeon that day. Those can be sent out and referred to an orthopedic surgeon as an outpatient procedure.
- Q: Talk about open fractures and how you treat those injuries.
- Leslie Barnes Remski, M.D.: Open fractures are typically treated with surgery by an orthopedic surgeon because of the risk of contamination of the bone through the open wound. This typically requires a surgery to wash out the bone in the wound, and then stabilize the fracture in whichever way is appropriate, then closing the wound after that. If there's any real complications with the wound such as wound breakdown or skin loss, other measures may be needed including plastic surgery or other procedures.
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