Open fracture

Open fracture is a type of bone fracture in which there is an open wound or break in the skin near the site of the broken bone. Typically, this can involve damage to the surrounding tissues, muscles, nerves, and blood vessels.

Causes

Open fractures are usually caused by high-energy trauma such as car accidents, falls from height, and sports injuries. They can also occur from low-energy trauma in people with poor bone quality, such as those with osteoporosis.

Classification

Open fractures are classified according to the Gustilo open fracture classification, which is based on the mechanism of injury, the extent of soft tissue damage, and the degree of contamination.

• Type I: The wound is less than 1 cm and clean.
• Type II: The wound is larger than 1 cm but without extensive soft tissue damage or avulsions.
• Type III: This is further subdivided into:
  • Type IIIA: Adequate soft tissue coverage of the fractured bone despite extensive soft tissue laceration or flaps, or high-energy trauma regardless of the size of the wound.
  • Type IIIB: Extensive soft tissue loss with periosteal stripping and bone exposure. This is usually associated with massive contamination.
  • Type IIIC: Associated with an arterial injury requiring repair, irrespective of degree of soft tissue injury.

Treatment

The treatment of open fractures aims to prevent infection, promote bone healing, and restore function. This typically involves a combination of antibiotics, surgery to clean the wound and fix the fracture, and sometimes further surgeries to cover the wound.

Complications

Complications of open fractures can include infection, non-union of the fracture, and compartment syndrome.

See also

• Bone fracture
• Compartment syndrome
• Osteoporosis

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  Open fracture illustration
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  Flowchart for treatment of open fractures