Open Fractures and Broken Bones (Compound Fractures)

Injuries to the Bone with Associated Soft Tissue and Skin Damage

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An open fracture is a broken bone that penetrates the skin. This is an important distinction because when a broken bone penetrates the skin there is a need for immediate treatment, and an operation is often required to clean the area of the fracture. Furthermore, because of the risk of infection, there are more often problems associated with healing when a fracture is open to the skin.

Open fractures are typically caused by high-energy injuries such as car crashes, falls, or sports injuries. Joe Theismann, a professional football player, famously ended his career with an open fracture that occurred on national television.

The severity of an open fracture is generally classified according to a system called the Gustilo-Anderson open fracture classification system. This classification system gives information about the likelihood of infection and the anticipated time for healing of an open fracture.

Infection & Open Fractures

All open fractures are considered contaminated because of the communication between the fracture site and the environment outside of the body. While actual rates of contamination can vary, all open fractures should be considered to be contaminated. The likelihood that bacteria have entered the fracture site is dependent on a number of variables including the severity of the injury, the damage to soft-tissues, and the environment where the injury occurred. 

The most likely bacteria to contaminate a wound are the normal bacteria that are found on the skin surface of your body. That's why the vast majority of open fracture infections are contaminated with Staph or Strep infections. Open fractures in the foot may involve other bacteria. In addition, open fractures in specific environments may lead to exposure to specific bacteria. For example, farmers who sustain open fractures that are contaminated with farm soils have different types of infections that may require specific antibiotic treatment.

Treatment of Open Fractures

Open fractures require urgent surgery to clean the area of the injury. Because of the break in the skin, debris and infection can travel to the fracture location, and lead to a high rate of infection in the bone. Once an infection is established, it can be a difficult problem to solve. 

The timing of surgery is a subject of debate, as traditionally orthopedic surgeons have recommended surgery performed within six hours of the injury. More recently, some data has supported performing surgery with slightly less urgency, but within 24 hours of the injury.

In addition to surgical cleansing of the wound, treatment should include appropriate antibiotics and stabilization of the fracture. Patients should receive a tetanus shot if they are not up-to-date or are unaware of their vaccination status.

Treatment of established bone infections often requires multiple surgeries, prolonged antibiotic treatment, and long-term problems. Therefore, every effort is made to prevent this potential problem with early treatment. Despite this early treatment, patients with an open fracture are still highly susceptible to bone infections.

Recovery from an Open Fracture

Open fractures usually take longer to heal because of the extent of injury to the bone and the surrounding soft-tissues. Open fractures also have a high rate of complications including infection and non-union. Timely treatment can help avoid problems associated with open fractures. Emergency care will involve antibiotics, cleaning of the fracture site, and stabilization of the bones.

Even with these proper treatment steps, the healing of an open fracture typically takes longer and a comparable closed fracture injury. For example, if a tibia fracture is a closed injury, it may take an average of 3 months for healing where is an open fracture may take 4-6 weeks longer even if the fracture pattern is similar. As the severity of the open fracture increases, the likelihood of complications, and the length of time for healing, also increases proportionally.

A Word From Verywell

Open fractures or serious injuries that require urgent medical treatment. While there is variation in the exact protocol of management of an open fracture, in general they will always require antibiotic administration and surgical cleansing. In addition, the prognosis following an open fracture depends on the severity of the soft tissue injury. Overall, the risk of complication including infection and delayed healing is higher when the soft tissue injury is more severe.

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Article Sources

  • Halawi MJ, Morwood MP. "Acute Management of Open Fractures: An Evidence-Based Review" Orthopedics. 2015 Nov;38(11):e1025-33.