Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
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.
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.
Open fractures can be classified according to the Gustilo classification system (Figures 24.1, 24.2, and 24.3; Table 24.1).
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%.