This article is co-written by Jonas DeMuro, MD. Dr. DeMuro is a certified pediatric surgeon, specialist in emergency surgery from New York. He graduated from Stony Brook University School of Medicine in 1996.
The number of sources used in this article is 13. You will find a list of them at the bottom of the page.
An open fracture occurs when the sharp edges of a broken bone penetrate the skin and protrude from the body, or a foreign object causes a penetrating wound that affects the bone. This type of fracture requires immediate first aid measures to reduce the likelihood of infection and ensure proper healing.
First aid, treatment, and prognosis of the disease for recovery and life depend on the localization of the injury, concomitant damage to blood vessels and nerve trunks, the development of complications.
According to the mechanism of injury, open fractures are:
- primary open - bone fragments exit through a defect in the skin occurs at the time of injury,
- secondary open - the formation of a wound by the sharp edges of a deformed bone occurs after an injury due to improper transportation or the provision of first aid.
By the location of the fracture line:
- comminuted with the formation of small or large bone fragments.
According to the location of the injury, open fractures are:
By severity, fractures are:
The severity of the injury is determined by the size of the damaged bone, the occurrence of venous or arterial bleeding, pain shock, fat embolism, phlegmon limbs, sepsis.
The clinical manifestations of an open fracture are basically the same as with a closed injury. The main difference is damage to the skin and the formation of a wound in which areas of the deformed bone are visible. In this case, the symptoms are more pronounced, and the diagnosis is not in doubt until instrumental examination methods are performed. Open injuries usually occur with displacement of bone fragments, so such fractures require long-term treatment and rehabilitation.
Signs of an open fracture:
- intense pain in the area of injury, which intensifies when moving,
- a wound of various sizes, at the bottom of which bone fragments are found,
- swelling of the injury site,
- venous or arterial external bleeding,
- limb deformity and pathological mobility (movement in an atypical place),
- crunch at the site of injury when moving or feeling the damaged bone,
- worsening of the general condition - increased heart rate, lowering blood pressure, blanching of the skin, psychomotor agitation.
Fractures that are accompanied by bleeding, especially from large arterial vessels, can lead to hemorrhagic shock. Damage to large bones or multiple injuries increase the risk of developing fatty embolism of the vessels of the heart and lungs. Injuries to bones and skin often lead to irritation of a large number of nerve receptors and cause the appearance of pain shock. The wound formed by bone fragments is infected with the formation of phlegmon limbs and sepsis. The listed complications of a fracture can be fatal if medical care is rendered late.
The provision of first aid
In the event of an open fracture, it is urgent to call an ambulance team to provide emergency care and transport the victim to the trauma or intensive care unit.
If it is impossible to call a team of physicians, it is necessary to independently carry out medical measures to prepare the patient for hospitalization in a medical institution. The rules of first aid for an open fracture should be known to everyone. The preservation of the health of the victim depends on this. Slowness and inaction can cost a sick person life.
First aid for open fracture:
- The victim should be removed from the scene if there is a risk of injury.
- When arterial bleeding occurs, which is characterized by a pulsating blood jet of scarlet color, a tourniquet is applied above the site of injury. Use a rubber medical tourniquet or use improvised means - a rope, belt, tie, which are applied to a cloth or clothing. Fix the time of applying the tourniquet.
- If venous bleeding occurs, which is accompanied by a sluggish blood stream of cherry color, it is enough to apply a pressure bandage below the site of injury.
- The edges of the wound must be treated with an antiseptic solution - brilliant green, hydrogen peroxide, iodine. The wound is covered with a sterile gauze dressing.
- You can not try to independently adjust and match bone fragments. Such actions can lead to increased bleeding and the development of pain shock.
- The victim is given painkillers in tablets or an intramuscular injection is given - analgin, diclofenac, pentalgin. This improves the general condition of the patient and prevents the appearance of traumatic shock during hospitalization in a medical institution.
- A transport tire is placed on the injured limb. Standard tires are used: vacuum, wire Cramer, wooden Dietirichs. Tires are applied from the intact skin integument taking into account the fixation of the overlying and underlying joint. In the absence of standard devices, improvised tires from pipes, ski poles, boards, thick cardboard, umbrellas are used.
- Standard or improvised tires are applied to clothing, tightly bandaged to the limbs. Cotton or soft tissue is placed under the bony protrusions. To treat wounds, clothes are cut.
- An ice pack can be placed on the area of injury. This reduces blood loss and eliminates pain.
- The victim in a prone position or half-sitting is urgently transported to the nearest medical institution.
The most common open fracture of the arm. Lower limb injuries are recorded less frequently. Properly provided medical care reduces the risk of disability and death at the prehospital stage.
Diagnostics and treatment tactics
Diagnosis of open fractures is usually not difficult. Deformation of the limb and a wound with bone fragments are considered absolute signs of a fracture. To clarify the diagnosis and degree of tissue damage, instrumental examination methods are prescribed: radiography, computed or magnetic nuclear tomography. An x-ray detects bone defects, the severity of damage to bone tissue is detailed on a CT scan. Magnetic nuclear tomogram helps detect damage to soft tissues (blood vessels, nerves, muscles).
An open fracture is rarely treated conservatively. With a slight displacement of bone fragments, they are compared under local anesthesia. Then a plaster cast is applied to immobilize the injured limb in order to form bone callus in the area of bone damage. The wound is treated with antiseptic solutions, areas of dead tissue are removed and the skin defect is sutured. A window is left in the cast to monitor the wound and daily antiseptic treatment.
Surgical treatment of a fracture is much more often prescribed. Bone fragments are compared and immobilized with screws, staples, plates or knitting needles. The most effective and convenient method of surgical intervention is the use of compression-distraction external fixation devices, which are called Ilizarov devices. The use of special fixing structures does not limit motor activity and allows you to treat a wound above the fracture site.
After removal of the plaster or Ilizarov apparatus during the rehabilitation period, physiotherapy, massage, and therapeutic exercises are prescribed. This helps restore muscle strength, joint mobility, elasticity of the ligaments of the affected limb, normalize the metabolism and blood circulation of injured tissues. Patients return to their usual physical activity after 4-6 months. In severe cases, rehabilitation can last much longer.
An open fracture is a severe bone injury, which can be accompanied by pain and hemorrhagic shock, infection of the wound with the development of phlegmon and sepsis. The correct provision of first aid, timely hospitalization of the patient in the trauma unit and adequate therapy prevent the development of complications and the appearance of disability.