Open fractures are fractures where the bone breaks through the skin. An open fracture is a serious injury as it is prone to infection of the wound and bone, which may lead to delayed healing and risk for limb amputation. High energy collisions or accidents, and forceful twisting movements lead to open fractures. These fractures can vary in severity. The bone can fragment across or along the bone, and may break into multiple pieces. They are usually accompanied with additional injuries to the adjacent muscle, tendons, nerves and blood vessels.
When you present with an open fracture your doctor will review your medical history and closely examine the wound for associated injuries. An X-ray is ordered to assess the type and severity of the fracture.
The wound is cleansed of dirt, foreign objects, and unhealthy or contaminated tissue, and irrigated with normal saline. Antibiotics are started as early as possible to prevent infection. The fracture fragments are manually reduced as much as possible to prevent soft tissue damage and a light dressing is placed over the wound. A splint may be applied for protection until surgery.
Surgery is performed to align bone fragments more precisely and hold the fragments together. This may be accomplished by internal fixation where the fragments are held together with a plate and screws over the outer bone surface. Rods may also be passed through the center of the bone in the marrow cavity. If there is extensive soft tissue damage, external fixation methods are employed. Pins and screws are inserted into the bone above and below the fracture site and are then fixed to a stabilizing frame that holds the fragments together from outside. Once soft tissues have healed, internal fixation methods can be used for more stable fixation. In cases of major soft tissue loss, a flap of skin and muscle is taken from another region of the body (back or abdomen) to cover the wound.