Management of open fractures

When a bone is broken and is penetrating through the skin it is known as open fracture. Open fractures need urgent medical attention as the protruding bone may cause infections and there can be problems about the healing of the wound also. Open fractures are usually caused by high energy injuries like motor vehicle accidents, air crashes and injuries caused in sport activities.


Gustilo Anderson system for classification of open fractures is the system used for classifying an open fracture. This system of classification has the added advantage that it provides information regarding the occurrence of infection and the expected time for complete healing of the fracture.

Open fracture classifications

  1. Grade I. In this type of fractures there will be a wound about 1 cm in size which communicates with the fractured bone. In some cases the connection of wound to the fractured bone cannot be ascertained. This can be determined by injecting some fluid into the fracture site and observing whether the liquid is pouring out through the wound.
  2. Grade II. In this type of fractures there will be an open wound which will be more than one cm and soft tissues near the wound will also be injured.
  3. Grade III. In this type of fractures the associated injuries are very severe. Grade three has four sub categories.
    • Grade III A. In this type, fractures consist of high energy injuries connected with segmented bones and soft tissue injuries. Even if the wound is not large most surgeons considers high energy fractures as grade III A
    • Grade III B. In this type of fractures, bone is exposed and severe soft tissue damages are also noticed.
    • Grade III C. In this type of fractures severe vascular damage is involved.

As the bone is protruding through the fracture, there are all possibilities that the infection at the open end of the wound may travel inside and cause infection to the bone and become a difficult problem to be settled. Traditional orthopedic surgeons prefer a surgery within 6 hours. But the latest thinking in this field suggests that the surgery need be done within 24 hours of the occurrence of the injury.

Most patients with open fractures are subjected to a surgery commonly known as irrigation and debridement.”Irrigation means cleansing the bone involved in the surgery and debridement means removal of debris of bone parts and human tissues from the fracture site.

Usually a tetanus injection will be given immediately, if the patient has no idea about the details of the last such injection taken by him. The wound should be surgically cleaned and antibiotics and medication for stabilization of the injury will also be given. Non-union of the fractured bones and occurrence of infection are the most common complications that accompany open fractures.


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