Management of open fractures

Robert Blease, Enes Kanlić, Robert Blease, Enes Kanlić

Abstract

The large spectrum of open fractures is an amalgamation of injuries with the single variable in common of communication of the fractured bone with the outside environment, and thus an increased risk for infection. Contributing to the presence of bacteria within the fracture site is devascularized soft tissue, the degree of which can be directly attributed to the amount of energy imparted to the tissues. The currently used classification system aids in defining the degree of severity of these injuries and their subsequent risk for infection. The basic management principal for all of these injury patterns remains essentially the same, however: prevention of infection through debridement, wound management, antibiotic usage, and fracture stabilization. Frequently multiple surgical procedures will be required in order to obtain an infection free, united fracture with adequate soft tissue coverage (1).

Figures

FIGURE 1
FIGURE 1
A. X-ray of midhsaft comminuted tibia fracture and high fibula fracture. B. Clinical photo on admission presenting posteromedial soft tissue defects. C. Photo after debridements and “traveling external fixator frame in place. D. Proximal pin is in distal femoral condyles, distal pin into calcaneus. F. Clinical photo of healed soft tissues after local soleus muscle flap and fasciocutaneous flaps have been used. F. X-ray of healed fractures with locked intramedullary nail. Nailing was performed fifth day after injury, immediately before soft tissue coverage with local flaps.
FIGURE 2
FIGURE 2
A. X-ray of segmental tibia fracture and complex fibula fracture after motor vehicle collision injury. B. Clinical photo presenting proximal-medial wound, and very compromised soft tissue envelop around distal leg. C. Ring external fixator was applied, with minimal additional trauma, minimal risk of infection and good reduction and fixation.
FIGURE 3
FIGURE 3
A. X-ray of transverse humeral shaft fracture with some free fragments and foreign bodies. B. Clinical photo three hours after turn-over vehicle accident with posterolateral and anteromedial soft tissue defects. C. Clinical photo of locked compression plate covered well by soft tissues and put in immediately after irrigation and debridement, reprapping and redraping of the extremity. D. AP x-ray view of the healed fracture 16 months after injury. E. Oblique x-ray view with healed fracture and two classical screws used to achieve axial compression, and locked unicortical screws to enhance fixation. F. Early motion facilitated by stable fixation, healing without infection resulted in excellent function after couple of months, here on 16 month follow-up.

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Source: PubMed

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