References
Emergency management of open fractures
Abstract
Open fractures are associated with an increased risk of complications, such as infection or nonunion, and present a therapeutic challenge. The incidence of such complications is directly influenced by how they are treated in the first several hours after presentation. As such, the focus of this article is to adopt an evidence-based approach to guide open fracture emergency management and minimise complication rates. Upon initial presentation, the potential for concomitant life-threatening injuries should be investigated and the patient stabilised as necessary. Critical components of emergency management that have been shown to impact on complication rates include initial classification of the fracture, the prompt instigation of broad-spectrum systemic antibiotic therapy, the use of local antibiotics in select cases and copious wound irrigation using sterile saline. As long as antibiosis is attended to appropriately, small delays in wound debridement do not translate to increased complication rates and waiting for an experienced surgical team is recommended. In cases with no severe tissue damage or contamination, primary wound closure results in lower infection rates and can be recommended. In cases where primary closure is not an option, the wound should be sealed to prevent contamination with nosocomial pathogens.
An open fracture is defined as any fracture accompanied by a break in the skin that communicates with the fracture or its associated haematoma. They are characterised by contamination of the fracture site with microorganisms, and sometimes the introduction of foreign bodies into the wound (Zalavras, 2003). Moreover, depending on the severity of injury, there may be extensive damage to the soft tissue envelope and bone vascularity, which compromises healing potential. As a result, open fractures are associated with an increased risk of complications such as infection and nonunion and present a therapeutic challenge. The incidence of such complications is directly influenced by the emergency treatment approach and as such, the focus of this article is to help practitioners optimise their emergency management of open fractures and minimise complication rates.
The goals of open fracture management are prevention of infection, fracture union and restoration of function. These goals are best achieved by careful patient and injury assessment, including:
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