Fractures are common and almost everyone suffers at least once in their lifetime. However, this is not true for open fractures as they are more severe and result from high-energy trauma. Open fractures require emergency treatment as they are the common presentations to A&E. Urgent assessment and management by an orthopedic team is necessary in the case of open fractures. It is important to address such fractures timely as if left untreated, there is a high risk of morbidity and mortality. 

Different types of trauma implants like variable angle plate, bone screws, external fixators, or others are used during the treatment of open fractures and a team of orthopedic surgeons and assistance from other specialists will also be required. In this post, we will be discussing open fractures in detail along with their management and treatment. 

Pathophysiology of Open Fractures

As the name suggests, open fractures are those in which the bone protrudes out of the skin and contact with the external environment. There are 2 classifications of open fractures, “in-to-out” and “out-to-in” injuries. Let us explain both:

In-to-out Injury

This is when a sharp end of the bone penetrates the skin from below.

Out-to-in Injury

This is when something from outside enters the skin causing a fracture. For example, a ballistic injury. 

What Could Cause Open Fractures?

High-energy trauma like automobile accidents or a gunshot injury can cause open fractures. Such fractures are often associated with injuries to other parts of the body. Open fractures are severe and damage to soft tissues surrounding the bone is likely and it can be extensive. Not only severe fractures but acute fractures with an open wound are also considered open fractures. 

How Are Open Fractures Diagnosed?

The diagnosis of open fractures initially focuses on ruling out the possibility of life-threatening injuries. The initial protocol for ruling out such injuries is Advanced Trauma Life Support (ATLS). 

The diagnosis of such fractures also requires basic blood tests including a clotting profile along with radiography including x-rays and CT scans. 

Antibiotic injections are given as soon as possible to prevent infection. Besides this, a tetanus booster will also be given. Here, dressing is also applied to the wound and the injured limb will be put in a splint to prevent further movement of bones until surgery is done. 

What is the Treatment for Open Fractures?

Open fractures are severe and in almost all cases, surgery is required. The only difference here lies is in the type of surgery performed. But the surgery is not the first step of the treatment. At first, the surgeon will remove the foreign materials from the wound along with the damaged tissue. If the wound is small, the surgeon might extend it to easily access the injured bone.

After this, the wound will be irrigated using a saline solution to clean it. Once this is done, the bones will be realigned with external or internal fixation, whichever is feasible. 
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