Open Fractures: Why They Are a Surgical Emergency

Open (compound) fractures involve bone protruding through skin or a wound communicating with the fracture hematoma. They are orthopedic emergencies due to high complication rates.

Gustilo-Anderson Classification

• Type I: <1 cm wound, clean
• Type II: 1–10 cm, moderate soft tissue damage
• Type III: >10 cm, severe soft tissue loss, vascular injury, segmental fracture, farm injury

Major Risks

1. Infection: Direct inoculation; osteomyelitis, sepsis, amputation. Rates: Type I 1–2%, Type III 10–50%.
2. Soft Tissue Devitalization: Muscle/skin necrosis → flap coverage needs.
3. Vascular Injury: Popliteal, tibial arteries at risk; limb ischemia.
4. Compartment Syndrome: Swelling in closed fascial space → emergent fasciotomy.
5. Nonunion/Malunion: Devitalized bone, infection, instability.
6. Chronic Pain/Stiffness: Post-traumatic arthritis, nerve injury.

Urgent Management (Within 6–8 Hours)

1. ATLS primary survey
2. IV antibiotics (cefazolin + aminoglycoside ± penicillin for farm/soil)
3. Tetanus prophylaxis
4. Irrigation & debridement (OR) – multiple as needed
5. Stabilization: External fixator → delayed IM nailing/plating
6. Wound management: VAC, delayed closure/flap

Multidisciplinary team (ortho, plastics, vascular, ID) optimizes limb salvage and function.