How is an open fracture managed?

Washed out: Unless the opening is a simple pin prick size hole, surgery is indicated and the wound is opened and thoroughly washed out in the or to remove any foreign material that can lead to infection. If the fracture is mechanically unstable, an external fixator (pins through bone attached to an external frame) may be used to stabilize the injury until definitive care can be carried out.

Antibiotics: In addition to wash out of the wound and stabilization with an ex-fix, appropriate antibiotic coverage is also critical. The type of antibiotic selected by the physician will depend on many factors such as the extent of the injury, the environment where the injury occured and the overall health of the patient. Antibiotic beads are useful due to high levels of medication at the fracture site.

Protocol: The treatment of open fractures should follow standard protocols that have been shown to reduce the risk of complications, namely infection. 1. Give antibiotics based on the gustillo type (i, ii, iii) 2. Tetanus if needed 3. Operative debridement and irrigation 4. Surgical stabilization and aggressive soft tissue managment if necessary.