Open fractures

INTRODUCTION: Open fractures occur when the involved bone and surrounding soft tissues communicate with the outside environment because of a traumatic break in the overlying skin. Many open fractures are a result of high-energy trauma and are associated with severe soft-tissue injury. Lower energy open fractures occur when the skin break is caused by an “inside-out” injury. This occurs when a fractured end of the bone penetrates the overlying skin. EPIDEMIOLOGY: Fractures represent a major public health problem. The lifetime risk of fracture up to age 65 years is one in two, and every year, 1 in 118 people younger than 65 years of age sustains a fracture. Approximately 2% of all fractures and dislocations are open. CLINICAL FEATURES: Open fractures can be classified according to the Gustilo classification system (Figures 24.1, 24.2, and 24.3; Table 24.1). DIFFERENTIAL DIAGNOSIS: Key clinical questions that may help in the diagnosis of open fractures are: Is an open fracture the source of visible bleeding?, How large is the wound and how severe is the soft-tissue damage?, Are the joints above and below affected?, What is the neurovascular status of the affected limb?. TREATMENT AND PROPHYLAXIS: The rate of infection despite antibiotic administration in type I fractures range from 0% to 2%, in type II fractures from 2% to 10%, and in type III fractures from 10% to 50%.