Definition

An open fracture is a type of bone fracture that is accompanied by an open wound near the fracture site. This wound refers to a break in the skin, exposing underlying tissues such as muscles or bones to the environment. In an open fracture, the broken bone may protrude through the skin. The open wound is often caused by bone fragments piercing through the skin at the time of the injury. This condition increases the risk of bleeding and infection for the patient.

Open fractures require a different management approach compared to closed fractures, which do not have an open wound. This is because when the skin is broken, bacteria and other contaminants can enter the wound, increasing the risk of infection. Therefore, early treatment for open fractures focuses on preventing infection at the injury site. The wound, tissues, and bones must be cleaned surgically as soon as possible. The broken bone also needs to be stabilized for the wound to heal.

We have an article about fractures that you can read here: Fractures - Definition, Causes and Risk Factors.

Causes

Most open fractures are caused by high-energy injuries, such as motor vehicle accidents or falls from heights. The force is too great for the bone to withstand, leading to a fracture. Patients may also sustain additional injuries to other parts of the body.

An open fracture can also occur from low-energy injuries, such as falls at home or sports injuries.

Risk Factor

The risk of an open wound accompanying a bone fracture is higher in areas of the body where there is less soft tissue (such as muscle and fat) to protect the bone. This makes the bone more likely to be exposed to the external environment. For example, the lower leg is more susceptible to open fractures compared to the thigh.

Other factors that increase the general risk of bone fractures include:

• Being female, as women tend to have smaller, less dense bones compared to men. Additionally, women are at risk of losing bone density after menopause
• Individuals over the age of 50
• Smoking and excessive alcohol consumption
• Having chronic diseases such as diabetes or rheumatoid arthritis
• A history of previous bone fractures

Symptoms

Open fractures can vary in severity. In many high-energy injury cases, there is obvious skin loss, and the bone may be visible through the wound. In other cases, the wound may be no larger than a small hole, but muscle and bone tissue can still be seen.

In either situation, there can be significant damage to the surrounding soft tissues, including muscles, tendons, nerves, and blood vessels. Therefore, any bone fracture accompanied by an open wound is considered an open fracture.

The severity of an open fracture depends on several factors, including:

• The size and number of bone fragments.
• Damage to the surrounding soft tissues.
• The location of the wound.
• Whether blood flow to the soft tissue at the injury site is adequate.

The mechanism of injury, which can affect the degree of contamination. For example, in open fractures caused by motor vehicle accidents, contaminants like dirt, glass, or mud can enter the wound, increasing the risk of infection.

In an open fracture, you may experience the following symptoms:

• Sudden pain
• An open wound at the injury site
• The injured area may feel warm, appear red, or be swollen
• Difficulty moving the injured area
• Bleeding

Diagnosis

If you have an open fracture, the doctor will perform an initial examination and check for other injuries. They will inquire about how the injury occurred, current symptoms, and your medical history in detail.

The doctor will then examine the wound and the fractured bone, looking for damage to the soft tissues, nerves, and blood vessels. Open fractures typically involve both a broken bone and a wound in the same area.

The doctor may recommend imaging tests such as X-rays to determine the severity of the fracture. X-rays help visualize the number of bone fragments, their positions, and the alignment of the bones.

If a more detailed view of the bone and soft tissue is needed, additional imaging tests like CT scans or MRIs may be performed.

Management

To help prevent bacterial infections, you will be given antibiotics as soon as possible in the emergency room. You may also receive a tetanus shot if you haven't had one in the past five years. The injured area will be splinted to stabilize the bone and prevent movement.

Almost all cases of open fractures require surgery. It's important to perform surgery as soon as possible to clean the open wound and reduce the risk of infection. You may be given regional or general anesthesia during the surgery.

Surgical procedures may include:

• Wound Cleaning (Debridement)

This is the first step in controlling the risk of infection. During debridement, the doctor removes all foreign objects and contaminated materials (including damaged tissue) from the wound. The wound is thoroughly cleaned with several liters of sterile saline around the injured bone and soft tissue. Once the bone is cleaned, the doctor will evaluate the fracture and stabilize the bone.

• Internal Fixation

In this procedure, the doctor will place metal implants such as plates, rods, and screws on or inside the broken bone. The implants will keep the bone in place as it heals. Internal fixation is suitable for treating open fractures with:

• • Clean wounds,
  • Minimal or mild skin and tissue damage, and
  • Alignable bone fragments.

This procedure can be performed during the initial surgery or delayed if the soft tissues need time to heal. After surgery, the injured limb will be immobilized with a splint or cast until the fracture heals. You may be prescribed antibiotics for a period of time to prevent bacterial infections. During the healing process, the doctor will monitor the wound to ensure there are no signs of infection.

• External Fixation

If the wound and bone fragments are not suitable for permanent implants, the doctor may use external fixation on the injured limb. Most severe open fractures are initially stabilized with external fixation.

In this surgery, metal pins or screws are inserted into the bone above and below the fracture. These pins and screws extend outside the skin, where they are connected to metal or carbon fiber rods. External fixation stabilizes the damaged bone while the wound is cared for by the doctor.

Despite having external fixation devices, most patients can still remain mobile. In some cases, external fixation is used to stabilize the bone until complete healing. The device is removed after a second procedure when the fracture has healed.

Complications

Some complications of open fractures include:

• Infection

Open fractures have a high risk of infection. In general, the greater the damage to the bone and soft tissue, the higher the risk of infection. Bone infections are difficult to treat and may require long-term antibiotics and multiple surgeries. Thus, preventing infection is a key focus of treatment.

• Nonunion

Nonunion occurs when the fractured bone fails to heal after several months. Some open fractures may struggle to heal due to damage to the blood supply around the bone at the time of injury.

• Compartment Syndrome

This painful condition occurs when an injured limb swells, increasing pressure within the compartment (a space composed of muscles, nerves, and blood vessels). Immediate treatment is needed to relieve the pressure. Without treatment, compartment syndrome can cause permanent damage and loss of function in the limb.

Prevention

Most fractures are caused by accidents, such as falls or other injuries. To reduce the risk of fractures, you can:

• Maintain a healthy diet rich in vitamin D and calcium to keep bones strong
• Engage in weight-bearing exercises to help maintain bone strength
• Avoid tobacco products, as nicotine can increase the risk of fractures and delay healing

When to See a Doctor?

An open fracture, where the broken bone is visible protruding from the skin, is a medical emergency. Any injury to the spine is also considered a medical emergency.

Looking for more information about other diseases? Click here!