Prevention of open fractures
There is a need to implement prevention strategies1, such as promoting road safety, enhancing infrastructure, and raising awareness about the risks of high-energy trauma. Prevention involves both primary prevention (avoiding injuries), secondary prevention (treat the injuries adequately as soon as possible) and tertiary prevention (minimizing complications with adequate rehabilitation and additional reconstructions to improve function, e.g. contracture release, muscle transfers etc,)2.
Prevention of accidents in society
Road safety - Promoting safe driving practices, enforcing seatbelt and helmet laws, and improving road infrastructure can reduce road traffic accidents, a leading cause of open fractures3.
Workplace safety - Ensuring protective equipment and safety protocols in high-risk jobs, such as construction, can prevent fractures.
Fall prevention - In older adults, modifying homes, promoting balance exercises, and managing osteoporosis can reduce fall-related fractures4.
Public health and education
Awareness campaigns - Educating the public about road safety, bone health, and the importance of protective gear can reduce the incidence of open fractures5.
Bone health - Promoting calcium and vitamin D intake, and regular bone density screening for high-risk groups, helps maintain bone strength and prevent fractures6.
Healthcare system strengthening
Training healthcare workers - Training healthcare providers in trauma care and early fracture management can prevent complications, especially in LMICs7.
Infrastructure improvement - Strengthening emergency response and ensuring timely medical intervention can reduce infection risks and improve outcomes8.
Basics of Open Fractures Course
Timely intervention
Surgical treatment - Early debridement and stabilization, ideally within 6 hours of injury, significantly reduce infection risk and improve recovery9,10.
Policy measures
Legislation - Governments should enforce road safety and workplace safety laws and ensure access to affordable care to reduce fracture-related complications11,12.
Read more about WHO approach to increase road safety WHO approach.
Literature
1 Tajsic, N. B., Sambath, P., Nguon, S., Sokh, V., Chheang, V., Landsem, G., Zaletel, I., & Husum, H. (2017). Open Fracture Management in Low-Resource Settings: A medical training experience in Cambodian hospitals. World Journal Of Surgery, 41(12), 2981–2989. https://doi.org/10.1007/s00268-017-4245-7
2 Odatuwa-Omagbemi, D. O. (2019). Open fractures: epidemiological pattern, initial management and challenges in a sub-urban teaching hospital in Nigeria. Pan African Medical Journal, 33. https://doi.org/10.11604/pamj.2019.33.234.18141
3 World Health Organization. (2004). World report on road traffic injury prevention (M. Peden, R. Scurfield, D. Sleet, D. Mohan, A. A. Hyder, E. Jarawan, & C. Mathers, Reds.). https://iris.who.int/bitstream/handle/10665/42871/9241562609.pdf?sequence=1
4 National Institute on Aging. (2022, 12 september). Falls and fractures in older adults: Causes and prevention. U.S. Department of Health & Human Services, National Institutes of Health.
5 Åkesson, K., Marsh, D., Mitchell, P. J., McLellan, A. R., Stenmark, J., Pierroz, D. D., Kyer, C., & Cooper, C. (2013). Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporosis International, 24(8), 2135–2152. https://doi.org/10.1007/s00198-013-2348-z
6 Dawson-Hughes, B., Harris, S. S., Krall, E. A., & Dallal, G. E. (1997). Effect of Calcium and Vitamin D Supplementation on Bone Density in Men and Women 65 Years of Age or Older. New England Journal Of Medicine, 337(10), 670–676. https://doi.org/10.1056/nejm199709043371003
7 Achanga, B. A., Bisimwa, C. W., Femi‐Lawal, V. O., Akwo, N. S., & Toh, T. F. (2025). Surgical Practice in Resource‐Limited Settings: Perspectives of Medical Students and Early Career Doctors: A Narrative Review. Health Science Reports, 8(1). https://doi.org/10.1002/hsr2.70352
8 Ahmed, M. M., Oweidat, M., & Alsabri, M. (2025). Barriers to pediatric emergency care in low-resource settings: A narrative review. Sage Open Pediatrics.
9 Werner, C. M. L., Pierpont, Y., Pollak, A. N., & American Academy of Orthopaedic Surgeons. (2008). The Urgency of Surgical Débridement in the Management of Open Fractures. J Am Acad Orthop Surg, 16(7), 369–375. https://andreassauerbreymd.com/wp-content/uploads/2016/07/The-Urgency-of-Surgical-Debridement-in-the-Management-of-Open-Fractures.pdf
10 Rambani, R., Raman, R., Singh, J., Hashim, Z., & Sharma, H. K. (2012). The relationship between time to surgical debridement and incidence of infection in grade III open fractures. Strategies in Trauma And Limb Reconstruction, 7(1), 33–37. https://doi.org/10.1007/s11751-012-0130-y
11 World Health Organization, Murphy, E., Krug, E., Peden, M., & Khayesi, M. (2013). STRENGTHENING ROAD SAFETY LEGISLATION: A practice and resource manual for countries. https://iris.who.int/bitstream/handle/10665/85396/9789241505109_eng.pdf
12 Gupta, M., & Bandyopadhyay, S. (2020). Regulatory and Road Engineering Interventions for Preventing Road Traffic Injuries and Fatalities Among Vulnerable Road Users in Low- and Middle-Income Countries: A Systematic Review. Frontiers in Sustainable Cities, 2. https://doi.org/10.3389/frsc.2020.00010
Joost Binnerts, Nienke Smits, Abeba Aleka Kebede
Experts: Pieter Haasnoot
Editors: Job Wernand, Pim Bongers, Eva Alkemade, Matthijs Botman, Renz Wierper.