Open fractures: foundational concept
An open fracture is a fracture that communicates with the external environment through a wound in the skin and soft tissues. The communication may be obvious, or may be small and distant from the fracture; therefore, any fracture associated with a wound in the same limb should be considered open until proved otherwise. The severity is determined not merely by wound size, but by the extent of contamination, devitalisation of skin and muscle, periosteal stripping, vascular or nerve injury, bone loss, fracture configuration and the energy of injury.
Open fractures are orthopaedic emergencies because the protective barrier has been breached and the fracture is exposed to bacterial contamination. Devitalised tissue, dead space, haematoma and impaired perfusion provide a favourable environment for infection. The principal early objectives are preservation of life and limb, prevention of infection, restoration of perfusion, preservation of viable tissue, and achievement of stable skeletal and soft-tissue reconstruction.
Initial assessment relevant to classification
Assessment begins with the principles of trauma resuscitation. Haemorrhage, airway, breathing and circulation take priority over local wound examination. The injured limb is then assessed for distal perfusion, capillary refill, pulses, skin temperature, motor function, sensation and compartment tension. The neurovascular…