![]() The cookie is used to store the user consent for the cookies in the category "Analytics". This cookie is set by GDPR Cookie Consent plugin. These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. Infection – the rate of infection is very high following open fracture, due to direct contamination, reduced vascularity, systemic compromise (such as following major trauma) and need for insertion of metalwork for fracture stabilisation.Neurovascular injury – nerves and vessels may be compressed due to limb deformity, go in to arteriospasm, develop and intimal dissection or be transected altogether.Soft tissues – this can also range from very little tissue devitalisation to significant muscle/tendon/ligament loss requiring reconstructive surgery.Skin – this can range from a very small wound to significant tissue loss, whereby coverage will not be achieved without the aid of plastics surgery (i.e.The outcomes of an open fracture can be considered in the following way: Whilst any fracture can become open, the most common fractures are tibial, phalangeal, forearm, ankle, and metacarpal. ballistic injury or a direct blow) penetrates the skin, traumatising the subtending soft tissues and bone. This is most often through the skin – however, pelvic fractures may be internally open, having penetrated in to the vagina or rectum.įracture may become open by either an “in-to-out” injury, whereby the sharp bone ends penetrate the skin from beneath, or an “out-to-in” injury, whereby a high energy injury (e.g. PathophysiologyĪ fracture is ‘ open’ when there is a direct communication between the fracture site and the external environment. In this article, we look at the classification, investigations and management of open fractures. Left untreated, open fractures are associated with high rates of morbidity and mortality. Whilst most of these injuries can be safely managed on next day emergency lists, there are instances where emergency out-of-hours treatment is required. doi: 10.1097/OI9.Open fractures are a common presentation to A&E, and require urgent assessment and management by the orthopaedic team. Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time? OTA International: The Open Access Journal of Orthopaedic Trauma. Management of Gustilo–Anderson IIIB open tibial fractures in adults-a systematic review. Myatt A, Saleeb H, Robertson GAJ, Bourhill JK, Page PRJ, Wood AM. Clinical Orthopaedics & Related Research. Current concepts and ongoing research in the prevention and treatment of open fracture infections. Grade IIIC fractures specifically require vascular intervention, since the fracture is associated with vascular injury to the extremity.Grade IIIB fractures have significant soft-tissue damage or loss, such that bone is exposed, and reconstruction may require a soft-tissue transfer (flap) to be performed in order to cover the wound.Most surgeons classify high-energy fractures as IIIA even if the skin wound is not large. Grade IIIA fractures include high-energy fractures, as evidenced by severe bone injury (segmental or highly comminuted fractures) and/or large, often contaminated soft-tissue wounds.Grade III open fractures represent the most severe injuries and include three specific subtypes of injuries.Grade II fractures have larger soft-tissue injuries, measuring more than one centimeter.Sometimes it is difficult to assess if a fracture is open (meaning the wound connects to the broken bone), but this can be determined by injecting fluid into the fracture site and seeing if the fluid exits from the wound. ![]() A grade I open fracture occurs when there is a skin wound that communicates with the fracture measuring less than one centimeter. ![]()
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