Treatment principles in the management of open fractures

Abstract

The management of open fractures continues to provide challenges for the orthopedic surgeon. Despite the improvements in technology and surgical techniques, rates of infection and nonunion are still troublesome. Principles important in the treatment of open fractures are reviewed in this article. Early antibiotic administration is of paramount importance in these cases, and when coupled with early and meticulous irrigation and debridement, the rates of infection can be dramatically decreased. Initial surgical intervention should be conducted as soon as possible, but the classic 6 h rule does not seem to be supported in the literature. All open fractures should be addressed for the risk of contamination from Clostridium tetani. When possible, early closure of open fracture wounds, either by primary means or by flaps, can also decrease the rate of infection, especially from nosocomial organisms. Early skeletal stabilization is necessary, which can be accomplished easily with temporary external fixation. Adhering to these principles can help surgeons provide optimal care to their patients and assist them in an early return to function.

Keywords: Fracture principles; open fractures; trauma.

Figure 1

(a) Clinical photograph of a open fracture leg shows antibiotic bead pouch before occlusive dressing application. (b) Antibiotic bead pouch with occlusive dressing applied

Figure 2

(a) Clinical photograph of thigh shows Open wound prior to wound vacuum dressing. (b) Open wound appearance after wound vacuum dressing