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Open Fracture

Injuries to the Bone with Associated Soft Tissue and Skin Damage

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Updated November 07, 2013

open fracture

Fractures that penetrate the skin are called open fractures.

Image © Jonathan Cluett, M.D.

An open fracture is a broken bone that penetrates the skin. This is an important distinction because when a broken bone penetrates the skin there is a need for immediate treatment, and an operation is often required to clean the area of the fracture. Furthermore, because of the risk of infection, there are more often problems associated with healing when a fracture is open to the skin.

Open fractures are typically caused by high-energy injuries such as car crashes, falls, or sports injuries. Joe Theismann, a professional football player, famously ended his career with an open fracture that occurred on national television.

The severity of an open fracture is generally classified according to a system called the Gustilo-Anderson open fracture classification system.  This classification system gives information about the likelihood of infection and the anticipated time for healing of an open fracture.

Treatment of Open Fractures

Open fractures require urgent surgery to clean the area of the injury. Because of the break in the skin, debris and infection can travel to the fracture location, and lead to a high rate of infection in the bone. Once an infection is established, it can be a difficult problem to solve. 

The timing of surgery is a subject of debate, as traditionally orthopedic surgeons have recommended surgery performed within six hours of the injury.  More recently, some data has supported performing surgery with slightly less urgency, but within 24 hours of the injury.

In addition to surgical cleansing of the wound, treatment should include appropriate antibiotics, and stabilization of the fracture.  Patients should receive a tetanus shot if they are not up-to-date or are unaware of their vaccination status.

Treatment of established bone infections often requires multiple surgeries, prolonged antibiotic treatment, and long-term problems. Therefore, every effort is made to prevent this potential problem with early treatment. Despite this early treatment, patients with an open fracture are still highly susceptible to bone infections.

Recovery from an Open Fracture

Open fractures usually take longer to heal because of the extent of injury to the bone and the surrounding soft-tissues. Open fractures also have a high rate of complications including infection and non-union.  Timely treatment can help avoid problems associated with open fractures. Emergency care will involve antibiotics, cleaning of the fracture site, and stabilization of the bones.

Sources:

Zalavras CG and Patzakis MJ. "Open Fractures: Evaluation and Management" J Am Acad Orthop Surg May/June 2003; 11:212-219.

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