To treat open fractures effectively, we need to understand what they are and how they occur.

What is an open fracture?

Open fractures are also referred to as exposed or compound fractures.

An open fracture is a broken bone that has a direct communication between the fracture site and the external environment through a wound in the skin and/or soft tissues^1,2. In simple terms: there is both a break in the bone and a skin wound that exposes the fracture or its hematoma to the outside world.

Example - Even a very small skin puncture (from a sharp bone fragment poking out from the inside) qualifies the injury as an open fracture.

The disruption of both the bone and surrounding soft tissues leads to exposure to external contaminants such as dirt, bacteria, and other microorganisms. This exposure significantly increases the risk of infection¹. Severe soft tissue damage further hinders normal healing by impairing blood circulation, which can prevent the fracture site from receiving adequate nourishment and oxygen³.

Open Fracture of the Tibia

Management of open fractures poses a serious challenge to surgeons, both in high and low resource settings, despite recent advances in treatment protocols³. The most dangerous early complication is death due to blood loss. The most common complication is fracture related infection, potentially leading to sepsis, tissue necrosis and high risks on delayed and non-union of the fracture⁴.

The aim of treatment of open fractures is to enable healing of bone and other tissue involved with a good functional outcome. An open fracture can only be adequately managed when both bone and soft tissue components are treated¹.

Open fractures are surgical emergencies.

The sooner the treatment is provided, the better the outcome because it reduces the infection risk. That's why open fractures are medical emergencies, especially if they present early (which is almost always the case in high income settings). When patients present late (days or weeks after the injury), already with signs of sepsis, this is of course also an emergency. If the patient presents late without signs of sepsis, there is more time to optimize the patients' general condition and to plan the treatment with the best possible team in your setting¹.

Take into account that the timing of surgery should be a balanced decision between:

1 The need to act fast and

2 The time needed to be able to provide the best possible treatment, preferable by an experienced orthoplastic team.