Treatment

The importance of early identification of open fractures is paramount to treatment options, prevention of infection, and overall outcome. Incidence of infection is directly proportional to the degree of soft tissue injury from 0-7% in type I open fractures to 25-50% in type IIIC open fractures.6 Studies have shown that cultures taken in the emergency department are positive in 70% of open fractures. Therefore the initiation of intravenous antibiotic therapy as early as possible is of great impor-tance.1 Current literature supports the use of a first-generation cephalosporin for 2-3 days for Gustilo type I and II injuries. For type III open fractures an aminoglycoside should be added for 3-5 days. And in farm-related injuries, vascular compromise, or injuries related to severe crush, penicillin may be added to cover Clostridium perfringens and C. septicum.1,3,6

Open fractures require immediate extensive and meticulous debridement with copious irrigation performed in the operating room. Antibiotic bead chains or a bead pouch technique can be beneficial to help fight infection. Stabilization of the fracture fragments can be temporary or definitive, and the need for repeated debridements or flap coverage may affect which fixation modality is used. Fixation options include splinting and casting, traction, open reduction and internal fixation with plates and screws, intramedullary devices, and external fixation.

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