Open Fracture

An open fracture is one where the fracture breaks through the skin. This is also know as a compound fracture. An open fracture can also be where there is a wound that contacts the bone that causes a fracture and exposes the bone.

Grading of open fractures

Grading is important in determining the treatment of open fractures.

• Minor / Grade I - small puncture wound less than 1 cm associated with low velocity trauma. Minimal soft tissue injury. No crushing. No comminution.
• Moderate / Grade II - wounds which are extensive in length and width but with relatively little soft tissue damage, and only moderate crushing or comminution.
• Major / Grade III - wounds of moderate or massive size with considerable soft tissue injury and/or foreign body contamination:

Treatment of open fractures

Since the outer tissue is broken and the bone and surrounding tissue are exposed to contamination treatment usually requires some form of surgery or at least treatment to prevent infection.

The treatment of a open fracture involves the realignment of the ends of the fractured bones, and immobilization of the fracture, either by fixing the bone internally or by using external splints. The goal is to assist the bone to recover completely.

Immediate surgery is usually required for open fractures. Since the broken bone comes out of the skin, the affected bone can be highly susceptible to infection due to it being exposed to bacteria and debris. Once the bone gets infected, it is usually difficult to heal, often requiring a number of surgeries, antibiotic treatment for a prolonged period, along with other problems that last a long time. Hence, it is very important to get early treatment when a open fracture occurs. In fact, in spite of early treatment, infections of the bone are quite a common occurrence in people with a open fracture.

The long bones, such as the femur, or the thigh bone, which extends from the pelvis to the knee, are often difficult to be kept aligned, and hence, internal nailing is usually resorted to in adults. Traction may be required in children for two days or so before the bone is set in a cast. Once it is seen that both the ends of the fractured bone are beginning to heal, plaster of Paris is used to immobilize the hip and leg joint. Or, in other instances, a general anesthesia is given to the patient and pins inserted, both below and above the fractured area, which are then fixed to a fixator, or an external frame, in order to immobilize the affected area.

In certain bones, like the toe bones or the collarbone, a splint or sling is usually used in order to immobilize it, instead of using a plaster. If the bones in the ankle are affected, plates and screws may be used to immobilize it.