This document provides guidelines for managing compound fractures, including early treatment procedures like documentation and investigations, local wound management through repeated cleaning and debridement under anesthesia to remove all dead and contaminated tissue until bleeding edges remain, and stabilization techniques ranging from splints and casts to various types of external fixators.

1. Compound Fractures
Management
General & Local

2. Early
• Medico legal record
• Pt’s identification marks, Pt. bought by, Detailed
history & injury notes , Police information
• Investigations –Hemogram, BSL, BUN, S. Creatinin,
Blood grouping, X-ray, USG, CT scan
• Catheterization
• Renal perfusion - Hypotension, crush syndrome

3. Local
• As soon as patient is hemo dynamically stable at the
EARLIEST
• Cleaning
• Debridement
• Stabilization
• Under Anesthesia

4. Cleaning
• Repeated
• Using about 3 to 4 liters of normal saline till all the
foreign material is removed.
• May add mild detergent to Normal Saline
• Addition of antiseptics, H2O2, Not recommended as
it may injure soft tissues & discoloration will confuse
the vitality signs

5. Debridement
• Excision of all dead tissue
• Excision of all contaminated tissues with foreign material
which can not be removed by cleaning
• Including every piece of bone without soft tissue
attachment in spite of its size
• Soft tissue till bleeding edge
• Muscles till bleeding contractile pink muscle
• Send Culture Swab For C & S
• NO Sutures

6. stabilization
• Debridement repeated after 24 hours and there after
till no dead tissue remains
• Splints
• Simple
• Traction Splints- Fixed traction, Dynamic traction
• Plasters
• Slabs,
• Casts, Window dressing

7. External Fixators
• Uni- plainer
• Simple
• Complex Joint spanning
• Multi-plainer
• JESS
• Ring

8. External Fixator

10. External Fixator
Complex

11. Ring Fixator