Open Fracture Management

Open Fracture Complications

• Infection: most common complication, occurs in 2-16% of cases
  • Risk factors: severity of injury, delay in treatment, inadequate debridement
• Nerve damage: 10-20% of cases, especially in upper extremity fractures
• Vascular injury: 1-5% of cases, can lead to limb ischemia and amputation
• Compartment syndrome: 1-5% of cases, can lead to permanent nerve damage and muscle necrosis
• Non-union: 10-20% of cases, can lead to chronic pain and disability
• Arthritis: 10-20% of cases, can lead to chronic pain and decreased mobility

Treatment Options

• Debridement: removal of dead tissue and foreign particles to prevent infection
• Antibiotic therapy: used to prevent and treat infection
• Fracture stabilization: used to maintain bone alignment and promote healing
  • Internal fixation: plates, screws, and rods
  • External fixation: pins and frames
• Soft tissue management: used to promote wound healing and skin coverage
  • Skin grafting
  • Flap reconstruction
• Amputation: in severe cases, may be necessary to prevent further complications

Classification

• Gustilo-Anderson classification: based on severity of soft tissue injury
  • Type I: low-energy fracture, minimal soft tissue injury
  • Type II: moderate-energy fracture, moderate soft tissue injury
  • Type III: high-energy fracture, extensive soft tissue injury
• Tscherne classification: based on severity of soft tissue and bone injury
  • Grade 0: low-energy fracture, minimal soft tissue injury
  • Grade 1: moderate-energy fracture, moderate soft tissue injury
  • Grade 2: high-energy fracture, extensive soft tissue injury
  • Grade 3: severe fracture, severe soft tissue injury and bone damage

Rehabilitation

• Early mobilization: important for preventing stiffness and promoting healing
• Range of motion exercises: used to maintain joint mobility and prevent contractures
• Strengthening exercises: used to improve muscle strength and function
• Gait training: used to improve ambulation and prevent complications
• Pain management: used to manage chronic pain and promote functional recovery

Emergency Care

• Initial assessment: ABCDE (airway, breathing, circulation, disability, exposure) protocol
• Wound management: immediate debridement and dressing to prevent infection
• Fracture stabilization: temporary stabilization to prevent further injury
• Pain management: used to manage acute pain and promote comfort
• Transportation: urgent transportation to a trauma center for definitive care