Open fractures are known to be serious orthopedic emergencies that are associated with a high risk of infection and other complications like healing problems. It is seen that in most open fracture cases multiple injuries are often involved. Open fractures most commonly occur due to high-energy automobile collisions such as car or bike accidents. These fractures are also seen due to bomb blasts or car blasts. In certain cases, open fractures can be isolated as well.
High-velocity trauma like gunshot wounds or falling from a great height could also result in open fractures.
Overview of Open Fractures
Open fractures are complex injuries characterized by bone breaks and injuries to the soft tissue. In these orthopedic emergencies, the fractured bone comes out of the skin while making direct contact with the external environment. The condition is often reported with soft tissue damage and in certain cases, damage to the vascular supply is also noticed.
Avoiding life-threatening injuries first, infection prevention, fixation of the fracture, and restoring the normal function are the goals of open fracture management.
Open fractures of the lower extremity are known to be the most common, for example, the cases of open tibia fractures are reported the most. The maximum cases of open fractures reported are due to road accidents and falling from a height.
Classification of Open Fractures
Open fractures are classified based on the seriousness of the condition. Gustilo’s classification of open fractures is the key one. Let us see what it is:
Type I open fractures are defined as those injuries where the wound is <1 cm and the injury is clean along with a simple pattern of the fracture.
These are the types of fractures where the wound size is more than 1 cm plus, minimal soft tissue injury is there. In type II fracture, there are no avulsions or flaps.
Type III open fractures are the most serious out of all and they are further classified into three types including Type III – A, B, & C. Type III injuries are extensive and they could involve a multi-fragmented fracture, serious soft-tissue injury, vascular injury, or other traumatic complications. Type III – C injuries are the most severe ones.
Diagnosis of Open Fracture
Serious open fracture cases require quick initial assessment and management. This includes wound cleaning and debridement to remove injured & dead tissues to reduce infection chances. Taking the patient out of a life-threat is the first goal after diagnosis. The diagnosis of open fracture will also be done based on the Gusto classification system to analyze the line of treatment required by the patient.
Management of Open Fracture
The management of open fracture starts with a quick cleaning of the wound to reduce infection chances and administer antibiotics if required. Wound irrigation is also done as a part of the treatment procedure.
In most cases, surgical management of the open fracture is required to fix broken bone fragments and that will require the use of trauma implants. Orthopedic implants stabilize the fractured bone fragments and ensure their correct positioning while they heal.
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