Open Fractures

Definition
Complications
EC Management
Summary

Definition of an open fracture 

Osseous disruption with skin, soft tissue break that communicates with the fracture and hematoma. 

Complications 

1. Contamination of the wound and fracture. 
2. Devascularization results in soft tissue compromise and increases susceptibility to infection. 
3. Loss of tissue could alter the method of immobilisation. 

Classification of open fracture : Gustilo and Anderson (Open fractures)

• Type I
  • wound < 1 cm
• Type II
  • 1-10cm
• Type III A
  • > 10 cm, high energy
  • adequate tissue for coverage
  • includes segmental or extensively comminuted fractures even if wound <10cm
• Type IIIB
  • extensive periosteal stripping and requires free soft tissue transfer 
• Type IIIC
  • vascular injury requiring vascular repair

Emergency Centre Management 

• Haemorrhage should be treated with direct pressure. 
• Parental antibiotics – Grade I and II Cephalosporins – Grade III consider adding aminoglycoside 
• Normal saline dressing after irrigation. 
• Avoid probing the wound in the emergency centre. 
• Reduce and immobilise. 
• Check vascular status of affected limb before and after reduction. 
• Tetanus toxoid. 

Summary 

Key to successful fracture management is to ensure the following is achieved as best as the unit / staffing compliment can provide : 

• Analgesia 
• Reduction 
• Immobilisation / Splinting 
• Consultation with orthopaedic team