Table of ContentsView AllTable of ContentsSurgical CleaningRemoving TissueStabilizing the BoneAntibioticsTiming of EventsPrognosis
Table of ContentsView All
View All
Table of Contents
Surgical Cleaning
Removing Tissue
Stabilizing the Bone
Antibiotics
Timing of Events
Prognosis
An open fracture is an injury that occurs when abroken boneis exposed through the skin. The bone could actually protrude out of the skin, or the skin and soft-tissue could be severely injured, exposing the fracture. Often called a compound fracture, an open fracture is treated differently than aclosed fracture.
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Surgically Cleaning the Bone
Surgically cleaning the bone is one of the first steps for treating an open fracture. Irrigation, washing the bone and the site of the injury, is part of the surgical repair.
This is usually done in the operating room (OR) under anesthesia. Cleaning the injury in the emergency room without adequate anesthesia may be necessary, but it is often insufficient.
Removing Contaminated or Non-Viable Tissue
The second step of open fracture surgery,debridement, involves removing material (such as dirt, gravel, or clothing) and non-viable tissue.
Determining tissue viability can also be a challenge, and in severe open fractures, multiple surgical procedures may be needed to avoid removing excess tissue while also ensuring that all nonviable tissue has been removed.
One way of assessing whether tissue is viable is based on its blood supply. Without an adequate blood supply, the tissue would be unlikely to survive and could be susceptible to infection.
Stabilizing the fractured bones positions the bone for healing and helps prevent further tissue damage.
The best method of stabilizing bone depends on a number of factors. Many standard methods of stabilizing bone—such as placement of plates, screws, orintramedullary rods—may not be good options if there is a high chance of bacterial contamination. Often, anexternal fixatoris used to stabilize bones in open fractures.
External fixators have a few distinct advantages in this setting:
The appropriate type of fixation for an open fracture depends on factors such as the location and extent of the injury.
Antibiotic Administration
Antibiotics are used to prevent and treat an infection, and this medication is among the most important aspects of treating an open fracture.
The most appropriate antibiotic depends on the type and severity of the injury. If the injury occurred in a contaminated environment, such as a farming accident, for example, this would direct antibiotic selection.
Antibiotics are usually administered as soon as possible, even before irrigation and debridement, and they are usually continued for 72 hours after treatment. If an infection develops, antibiotics may be continued even longer, or the antibiotic might be changed to specifically treat the infectious organism.
Open fractures need to be treated quickly and safely, and evaluation should not be delayed. These injuries are usually surgically treated within six to 12 hours of the injury.
If the safest treatment involves a time delay, that may be appropriate, as long as antibiotics are started immediately.
Prognosis of Open Fractures
The prognosis of an open fracture depends on the severity of the injury. Overall, healing from an open fracture takes longer than it does with a closed fracture.
Complications are more common after open fractures than they are with closed fractures. Sometimes the bone doesn’t heal, a condition described as non-union.The best way to prevent complications is to seek urgent medical treatment and follow-up with your physician after surgery.
Open fractures are classified as Grade I, Grade II, and Grade III, with higher grades corresponding to more extensive injuries. Grade I injuries may heal as well as a closed fracture. Grade III injuries have a high risk of infection or nonunion and may take much longer for healing.
A Word From Verywell
An open fracture is a medical emergency that requires urgent evaluation and prompt treatment. Open fractures are serious injuries that can lead to complications like infection and delayed bone healing. Many open fractures will require urgent surgical treatment to clean out and stabilize the bone. In addition, antibiotic treatment is always necessary to lower the chance of infection. Even with ideal treatment, the risk of complications associated with open fractures is high.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Open fractures.Hoff WS, Bonadies JA, Cachecho R, et al.East practice management guidelines working group: update to practice management guidelines for prophylactic antibiotic use in open fractures.J Trauma. Mar 2011;70 (3): 751-4. doi:10.1097/TA.0b013e31820930e5You DZ, Schneider PS. Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time?OTA Int. 2020;3(1):e067. doi:10.1097/OI9.0000000000000067Patzakis MJ, Levin LS, Charalampos GZ, et al.Principles of open fracture management.Instr Course Lect. 2018 Feb 15;67:3-18Kim PH, Leopold SS.Gustilo-Anderson classification.Clin Orthop Relat Res.2012 Nov; 470(11): 3270–3274. doi:10.1007/s11999-012-2376-6Additional ReadingHalawi MJ, Morwood MP.Acute management of open fractures: an evidence-based review.Orthopedics. 2015;38(11). doi:10.3928/01477447-20151020-12
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Open fractures.Hoff WS, Bonadies JA, Cachecho R, et al.East practice management guidelines working group: update to practice management guidelines for prophylactic antibiotic use in open fractures.J Trauma. Mar 2011;70 (3): 751-4. doi:10.1097/TA.0b013e31820930e5You DZ, Schneider PS. Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time?OTA Int. 2020;3(1):e067. doi:10.1097/OI9.0000000000000067Patzakis MJ, Levin LS, Charalampos GZ, et al.Principles of open fracture management.Instr Course Lect. 2018 Feb 15;67:3-18Kim PH, Leopold SS.Gustilo-Anderson classification.Clin Orthop Relat Res.2012 Nov; 470(11): 3270–3274. doi:10.1007/s11999-012-2376-6Additional ReadingHalawi MJ, Morwood MP.Acute management of open fractures: an evidence-based review.Orthopedics. 2015;38(11). doi:10.3928/01477447-20151020-12
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopaedic Surgeons.Open fractures.Hoff WS, Bonadies JA, Cachecho R, et al.East practice management guidelines working group: update to practice management guidelines for prophylactic antibiotic use in open fractures.J Trauma. Mar 2011;70 (3): 751-4. doi:10.1097/TA.0b013e31820930e5You DZ, Schneider PS. Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time?OTA Int. 2020;3(1):e067. doi:10.1097/OI9.0000000000000067Patzakis MJ, Levin LS, Charalampos GZ, et al.Principles of open fracture management.Instr Course Lect. 2018 Feb 15;67:3-18Kim PH, Leopold SS.Gustilo-Anderson classification.Clin Orthop Relat Res.2012 Nov; 470(11): 3270–3274. doi:10.1007/s11999-012-2376-6
American Academy of Orthopaedic Surgeons.Open fractures.
Hoff WS, Bonadies JA, Cachecho R, et al.East practice management guidelines working group: update to practice management guidelines for prophylactic antibiotic use in open fractures.J Trauma. Mar 2011;70 (3): 751-4. doi:10.1097/TA.0b013e31820930e5
You DZ, Schneider PS. Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time?OTA Int. 2020;3(1):e067. doi:10.1097/OI9.0000000000000067
Patzakis MJ, Levin LS, Charalampos GZ, et al.Principles of open fracture management.Instr Course Lect. 2018 Feb 15;67:3-18
Kim PH, Leopold SS.Gustilo-Anderson classification.Clin Orthop Relat Res.2012 Nov; 470(11): 3270–3274. doi:10.1007/s11999-012-2376-6
Halawi MJ, Morwood MP.Acute management of open fractures: an evidence-based review.Orthopedics. 2015;38(11). doi:10.3928/01477447-20151020-12
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