Open Fractures
Most open fractures can be safely taken to the operating theatre the next day for washout and further management. Previously prevailing dogma, known as the ‘Six Hour Golden Rule’, held that open fractures require operative repair within 6 hours of injury to decrease the risk of osteomyelitis - Chris Nickson
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HWN Suggests
An Open-and-Shut Case? Diagnosis and Management of Open Fractures in the Emergency Department
Open fractures have much higher rates of infection, up to 25%, depending on a number of factors. The most important way to reduce infection rate is early administration of antibiotics, so prompt identification of an open fracture is crucial.
Another consideration with open fractures is to remember that compartment syndrome is still possible, despite the soft tissue disruption. One study found that, among patients with open tibial fractures, the rate of compartment syndrome was 9.1%.[2], although tibial fractures tend to develop compartment syndrome more often than other locations, so the rates associated with other sites is likely lower. Interestingly, the majority of open fractures…
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Gustilo Anderson Open Fracture Classification
Gustilo-Anderson is the most common grading system for open/compound fractures. It risk stratifies the patient and guides management.
Open Fractures: “It's not supposed to look like that”
The most common sites of open fractures are the phalanxes and tibia. Importantly, and perhaps the most critical lesson in this review: never let an open fracture distract you from your standard trauma protocols. ABCs first. Always.
Open Breaks - Initial Management
Open fractures are a common pathology seen in emergency departments, especially in trauma centers. In open fractures, the skin barrier has been compromised, exposing sterile bone to the environment. Considered a true orthopedic emergency, these fractures have high morbidity due to osteomyelitis, with infection rates up to 55%
Articles of Interest
Antibiotic Prophylaxis in Open Fractures
Open fractures are high energy injuries with an increased risk of infection due to potential exposure of bone and deep tissue to a variety of environmental debris. Infection can lead to serious complications including nonunion of wounds and osteomyelitis. Antimicrobial prophylaxis is indicated in open fractures and should be based upon the risk of infection. An order set severity based guidance is available...
Controversies in Initial Management of Open Fractures
Open fractures are one of the most challenging injuries in trauma care. Compared to closed fractures, they have a significantly higher risk of infection, nonunion, wound healing complications, and often require multiple surgeries for definitive care.
Open Fractures from Open Water
Special considerations should be given to patients who experience an open fracture in an aquatic environment. Trauma-related wounds exposed to water have a higher infection rate than land-based traumatic injuries and should be assumed to be exposed to aquatic pathogens. Injuries may occur in saltwater or freshwater environments
EM@3AM: Open Fracture
Treat patients with open fractures as trauma patients, looking for concomitant life-threatening injuries as well as vascular injuries and compartment syndrome from the fracture.
Open Breaks - Antibiotics for Open Fractures
Prompt administration of appropriate antibiotics has been shown to drastically reduce the incidence of osteomyelitis. From the literature, approximately 20% of the fractures that receive antibiotics later in their course developed osteomyelitis. In contrast, 5% of fractures that received antibiotics early in their course developed osteomyelitis.
Open Fractures
Do not irrigate, debride or probe wound in the ED if immediate operative intervention is planned. This may further contaminate the tissue or force debris deeper into the wound. If there is a delay to operative management, irrigate with saline and cover with a sterile dressing
Open Fractures Prophylactic Antibiotics
There is universal agreement that these wounds require emergency treatment as soon as possible to minimize infectious complications. To help standardize care and comparison of similar injuries in studies, Gustilo et al. classified open fractures into three categories...
Open Fractures – Initial Approach and Management
Open fractures are a time-dependent orthopedic emergency due to the risk of osteomyelitis.
Open Fractures – Pearls and Pitfalls
Open fractures are significant injuries that can lead to many complications if not treated appropriately and in a timely manner. The current literature shows that in the absence of timely antibiotics, infection can occur in up to 24% of cases. Studies have shown that delay in antibiotic administration >3 hours can result in an increased infection rate (7.4% versus 4.7%).
SplintER Series: Open Fracture
It is important to evaluate the extent of the wound. The length of the wound, the extensiveness of soft tissue damage, the environment in which the injury was sustained, and vascular involvement are all factors to evaluate in the ED. The Gustilo-Anderson classification system guides the management of these injuries.
Resources
Life in the Fastlane
An open fracture is a fracture that communicates with an overlying disruption of the skin and soft tissues. They are also called compound fractures. Open fractures are potentially limb-threatening injuries.
StatPearls
Open fractures occur secondary to trauma. They most commonly occur as high-energy injuries, but can also be a result of low-velocity trauma when the sharp ends of the fracture fragments pierce through the skin and soft tissue. High-energy, open fractures are often associated with other life-threatening conditions secondary to poly-trauma and pose other risks such as neurovascular injuries...
