This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Orthopaedics
[{'content': 'Open fracture is treated by -a) Tourniquetb) Internal fixationc) Debridementd) External fixation \nSelect and explain. \nA. bcd, B. acd, C. ac, D. bd', 'role': 'user'}, {'content': "Answer: A \nExplanation: Management of open fracture \n\nOpen fracture need immediate surgery to clean the area of the injury.\nBecause of the break in the skin, debris and infection can travel to the fracture location, and lead to a high rate of infection in the bone.\nOnce an infection is established, it can be a difficult problem to solve.\nTreatment of established bone infections often requires multiple surgeries, prolonged antibiotic treatment and long-term problems.\nTherefore, every effort is made to prevent this potential problem with early surgery.\nAll open fractures, no matter how trivial they are must be assumed to be contaminated.\nThe four essential principles of treatment for management of open fractures are : -\n\n\nAntibiotic prophylaxis\nUrgent wound and fracture debridement.\nStabilization of fracture (fracture fixation)\nEarly definitive wound cover \n\n\u200bDebridement\n\nPatient is taken immediately to surgery and debridement is done by removal of contaminated and devitalized tissue, copious irrigation by sterile solution (usually saline).\nAs a general rule it is best to leave cut nerves and tendons alone, though if the wound is absolutely clean and no dissection is require, and provided the necessary expertise is available, they can be sutured.\n\nWound closure\n\nA small, uncontaminated wound in a Grade I or II fracture may (after debridement) be sutured, provided this can be done without tension.\nIn the more severe grades of injury, immediate fracture stabilization and wound cover using split-skin grafts, local or distant flaps is ideal, provided both orthopaedic and plastic surgeons are satisfied that a clean, viable wound has been achieved after debridement.\nIn the absence of this combined approach at the time of debridement, the fracture is stabilized and the wound is left open and dressed with impervious dressing.\nReturn to surgery for a 'second look' should have definitive fracture cover as an objective. It should be done by\xa048-72 hours, and not later than 5 days.\n\nStabilizing the fracture\n\nStabilizing the fracture is important in reducing the likelihood of infection and assisting recovery of the soft tissues.\nThe method of fixation depends on the degree of contamination, length of time from injury to operation and amount of soft tissue damage.\nIf there is no obvious contamination and definitive wound cover can be achieved at the time of debridement, open fractures of all grades can be treated as for a closed injury. Internal fixation or external fixation depends on the individual characteristic of fracture.\nIf wound is contaminated and clean wound cannot be obtained by debridement or if wound cover is delayed, then\xa0external fixation by a fixator is safer.\n\nComing back to question\n\nDebridement, Internal fixation and external fixation all are used in the treatment of open fracture.\nFor one answer go ahead with debridement because debridement is the most important step and is done in all open fractures.\nOn the other hand, whether to stabilize the fracture either by internal fixation or external fixation, depends upon specific situations.", 'role': 'assistant'}]