Open fractures

Background

Open fracture means any fracture with communication to the outside environment. These can range from massive open wounds with soft tissue loss, to small in-out punctures. (note that these may not be immediately obvious so careful assessment of soft tissue is required near the fracture site)

Open fractures are associated with infections, neurovascular injuries and worse surgical outcomes, The soft tissue condition is one of the main determining factors that affect surgical decisions and subsequent management.

Open fracture can range from large open wounds with exposed bone (left), to small in-out puncture wound

Initial assessment and management (as per BOAST guidelines)

1. careful assessment and documentation of wound (site, size, contamination)

2. immediate IV antibiotics prophylaxis (antibiotics as per local guidelines) - ideally within 1 hr from the time of injury

3. consider tetanus booster (Revais)

4. assess for associated neurovascular injuries and compartment syndrome

5. wound handling should be kept to a minimum. (handle only to remove gross contaminants)

6. photograph wound

7. cover wound with saline-soaked gauze

8. realign and splint fracture

9. reassess neurovascular status, and repeat XR to check alignment

REFER ALL OPEN FRACTURES to ortho oncall

Large open wounds or vascular injuries should be directly referred to Kings College Hospital

gustilo anderson classification of open fractures