Treatment of an Open Fracture to Prevent Infection

An open fracture is an injury that occurs when a broken bone is exposed through the skin. The bone could actually protrude out of the skin, or the skin and soft-tissue could be severely injured, exposing the fracture. Often called a compound fracture, an open fracture is treated differently than a closed fracture.

Open fractures can heal slowly, and if complicated by an infection, serious problems with bone healing, systemic infection, or persistent problems with surrounding tissue can occur. Early treatment of an open fracture is focused on preventing infection and stabilization of the bone.

Surgically Cleaning the Bone

Surgically cleaning the bone is one of the first steps for treating an open fracture. Irrigation, washing the bone and the site of the injury, is part of the surgical repair.

This is usually done in the operating room (OR) under anesthesia. Cleaning the injury in the emergency room without adequate anesthesia may be necessary, but it is often insufficient.

Determining the extent of the injury can be difficult just by looking at an open fracture. This is especially true in high-energy injuries, including automobile collisions and gunshot wounds. With these types of injuries, even small penetrations in the skin cause extensive soft-tissue damage around an open fracture. Often, a larger incision that extends beyond the injury is needed to sufficiently clean the tissue.

Removing Contaminated or Non-Viable Tissue

The second step of open fracture surgery, debridement, involves removing material (such as dirt, gravel, or clothing) and non-viable tissue.

Determining tissue viability can also be a challenge, and in severe open fractures, multiple surgical procedures may be needed to avoid removing excess tissue while also ensuring that all nonviable tissue has been removed.

One way of assessing whether tissue is viable is based on its blood supply. Without an adequate blood supply, the tissue would be unlikely to survive and could be susceptible to infection.

Stabilizing the Bone

Stabilizing the fractured bones positions the bone for healing and helps prevent further tissue damage.

The best method of stabilizing bone depends on a number of factors. Many standard methods of stabilizing bone—such as placement of plates, screws, or intramedullary rods—may not be good options if there is a high chance of bacterial contamination. Often, an external fixator is used to stabilize bones in open fractures.

External fixators have a few distinct advantages in this setting:

• They can be positioned quickly, which is often necessary with severe trauma
• They allow for optimal wound management
• They secure the bone without placing foreign objects directly at the site of injury

The appropriate type of fixation for an open fracture depends on factors such as the location and extent of the injury.

Antibiotic Administration

Antibiotics are used to prevent and treat an infection, and this medication is among the most important aspects of treating an open fracture.

The most appropriate antibiotic depends on the type and severity of the injury. If the injury occurred in a contaminated environment, such as a farming accident, for example, this would direct antibiotic selection.

Antibiotics are usually administered as soon as possible, even before irrigation and debridement, and they are usually continued for 72 hours after treatment. If an infection develops, antibiotics may be continued even longer, or the antibiotic might be changed to specifically treat the infectious organism.

Timing of Events

Open fractures need to be treated quickly and safely, and evaluation should not be delayed. These injuries are usually surgically treated within six to 12 hours of the injury.

If the safest treatment involves a time delay, that may be appropriate, as long as antibiotics are started immediately.

Prognosis of Open Fractures

The prognosis of an open fracture depends on the severity of the injury. Overall, healing from an open fracture takes longer than it does with a closed fracture.

Complications are more common after open fractures than they are with closed fractures. Sometimes the bone doesn't heal, a condition described as non-union. The best way to prevent complications is to seek urgent medical treatment and follow-up with your physician after surgery.

Open fractures are classified as Grade I, Grade II, and Grade III, with higher grades corresponding to more extensive injuries. Grade I injuries may heal as well as a closed fracture. Grade III injuries have a high risk of infection or nonunion and may take much longer for healing.

A Word From Verywell

An open fracture is a medical emergency that requires urgent evaluation and prompt treatment. Open fractures are serious injuries that can lead to complications like infection and delayed bone healing. Many open fractures will require urgent surgical treatment to clean out and stabilize the bone. In addition, antibiotic treatment is always necessary to lower the chance of infection. Even with ideal treatment, the risk of complications associated with open fractures is high.