An open fracture requires different treatment than a closed fracture without an open wound. This is because open fracture fragments come into contact with the external environment from this wound and there is a risk of contamination of deep tissues and bone fragments with bacteria due to the wound. Therefore, early treatment for an open fracture focuses on preventing infection at the site of the injury.
Why does an open fracture occur?
Most open fractures result from some type of high-energy event, such as a firearm or motor vehicle accident. These patients often have additional injuries to other parts of the body. An open fracture can also result from a simple event such as a simple fall at home or an injury while playing sports.
What are the risks?
In open fractures, the greatest risk is contamination and contamination from the wound site. Depending on the energy causing the fracture, the size of the wound in the soft tissue, tissue (skin, muscle, tendon) losses, vascular and nerve injuries and fragmentation of the fracture or bone defects are very important. Depending on these damages, open fractures are classified in different degrees and problems such as infection, union problems, soft tissue problems are tried to be revealed.
Contamination: To some extent, the environment in which an open break occurs will affect the degree of contamination. Objects such as dirt, broken glass, grass, mud, or even the patient’s own clothes can be rubbed into an open wound. Knowing the environment in which your injury occurred can help your doctor determine the best course of treatment.
Infection: Open fractures pose an immediate risk of infection. In general, the greater the damage to bone and soft tissues, the greater the risk of infection. A bone infection can be difficult to treat. It may require prolonged antibiotics and multiple surgical procedures. In extreme cases where the infection cannot be cured and the patient’s life is threatened, even amputation may be necessary. Therefore, infection prevention is the focus of early treatment.
How is it treated?
In most patients with open fractures, the most important step of treatment begins in the emergency room. Careful examination of the open fracture, along with the care of the injured patient, is important in understanding the severity of the tissue defect, vascular nerve injury, and contamination. Cleaning the wound by washing and covering it with sterile dressings is the first treatment step. Considering that different examinations can be made at this stage, photographing should be done so that the wound does not open repeatedly, and the fracture should be stabilized with a temporary splint if possible. Another important point is the application of preventive antibiotics and tetanus vaccination according to the contamination situation. With the radiographs to be taken, the fracture pattern is understood and the necessary treatment planning is made.
After the patient is stabilized, the first step is to take the patient to the operating room and perform the necessary tissue debridement. In this process, all contaminated and dead tissues should be cleaned and healthy tissue should be reached. Depending on the degree of bone open fracture, the bone should be fixed with an external fixator or internal fixation methods.
In open fractures, depending on the degree and size of the soft tissue injury, the wound can be closed immediately or followed for a while with open or negative pressure wound closure method. When it is ensured that infection does not develop, the wound is closed with skin grafts or soft tissue flaps. When soft tissue healing is achieved and it is ensured that there is no infection, the external fixation material outside the bone can be removed and internal fixation can be started. In some open fractures, external fixation material can be used for permanent fracture healing.
The success of treatment in open fractures depends on the rapid prevention of infection, debridement as soon as possible and proper fracture healing, as well as appropriate rehabilitation of the patient.
After surgery, the injured limb is immobilized with a sling cast or splint until the fracture heals. Antibiotics are given for a period of time to help prevent infection. During the healing process, the doctor will check the wound to make sure there are no signs of infection. If necessary, more than one soft tissue and bone operation may be required until healing is achieved.