Open fractures occur when a broken bone punctures the skin. They are typically caused by high-energy trauma and often involve additional injuries. Open fractures are classified based on wound size, soft tissue damage, and degree of contamination. Management involves trauma resuscitation, splinting, antibiotics, tetanus prophylaxis, surgical debridement, and stabilization of the fracture, such as with external or internal fixation. Complications can include infection, nonunion of the bone, and chronic osteomyelitis if not properly treated.

2. OPEN
FRACTURES
DR.KHUSHAL KHAN KAKAR
SURGICAL RESIDENT

3. OPEN
FRACTURES
OUTLINE
1. DEFINITION
2. CAUSES
3. CLASSIFICATION
4. MANAGEMENT
5. COMPLICATIONS
6. SUMMARY

4. Definition
▪ Open fracture is defined as
an injury where the fracture
and the fracture hematoma
communicate with the
external environment
through a traumatic defect
in the surrounding soft
tissues and overlying skin.

5. CAUSE
 Most open fractures are
caused by some type of
high-energy accident, like
a motor vehicle collision.
These patients will often
have additional injuries to
other parts of the body.
 An open fracture can also
result from a lower-energy
incident, such as a simple
fall at home or an injury
playing sports.

6. CLASSIFICATION:
❖ Gustilo and Anderson
classification of open #
➢ BASED ON
1. Size of wound
2. Amount of soft tissue
injury
3. Presence/Absence of
NV injury
4. Degree of
contamination

7. Type I
Wound size is less then 1cm
Minimal soft tissue injury
Fracture NOT comminuted
Low energy trauma
Clean puncture wound

8. Type II
Wound size is more then 1cm less then 10cm
Moderate soft tissue injury (crushing injury)
Moderate comminuted fracture
Moderate energy trauma
Moderate contamination

9. Type IIIA
Wound size is MORE then 10cm
With adequate soft tissue coverage
Highly comminuted fracture
High energy trauma
High degree contamination

10. Type IIIB
Wound size is MORE then 10cm
Extensive stripping of soft tissues and periosteum from bone.
Highly comminuted fracture
High energy trauma
High degree contamination

11. Type IIIC
Wound size is MORE then 10cm
Neurovascular injury requiring repair
Highly comminuted fracture
High energy trauma
High degree contamination

12. Management:
Fracture management is initiated after initial
trauma survey and Resuscitations complete.
• ATLS protocol
• Analgesia
• Splinting
• Culture and sensitivity
• Antibiotic
• Tetanus prophylaxis
• Take photo
• Cover wound
• Surgical debridement
• Stabilization of #

13. Tetanus
Two forms of
tetanus
prophylaxis
Tetanus toxoid
vaccine (IM)
Dose = 0.5ml ,
regardless of
age
Tetanus
Immune
globulin (IM)
<5 years old
receive = 75 U
5-10 years
old receive =
125 U
>10 years
old receive =
250 U
Different site of
location with
separate
syringe

14. Antibiotic

15. Antibiotic

16. Antibiotic

18. Irrigation

20. The method to reduce and stabilize the
fracture depend on following:
1. Bone that is involved
2. Type of bone
3. Efficacy of the debridement
4. Patients general condition
5. Surgeons choice

21. Options available :
Splint (in closed
reduction)
External fixator
Internal fixator

22. Wound closure

24. Complications:

25. summary