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  • Print publication year: 2008
  • Online publication date: December 2009

24 - Open Fractures

from Part I - Systems
    • By Melinda Sharkey, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Serena S. Hu, Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511547454.025
  • pp 131-134

Summary

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%.

REFERENCES
Gustilo, R B, Anderson, J T. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg 1976;58-A:453–8.
Gustilo, R B, Mendoza, R M, Williams, D N. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;24:742–6.
Patzakis, M J, Harvey, J P, Ivler, D. The role of antibiotics in the management of open fractures. J Bone Joint Surg 1974;56-A:532–41.
Patzakis, M P, Wilkins, J.Factors influencing infection rate in open fracture wounds. Clin Orthop 1989;243:36–40.
Zalavras, C G, Patzakis, M J. Open fractures: evaluation and management. J Am Acad Orthop Surg 2003;11:212–9.