An open fracture (compound in older terminology) is a fracture associated with overlying soft tissue injury, creating communication between the fracture site and the external surface of the body. Although open fracture may initially convey the image of grossly exposed bone, the term is equally applicable to a simple puncture wound extending to the depth of an underlying fracture. Such puncture wounds may be created by external forces or by a sharp bone fragment transiently protruding through the skin before receding back beneath the surface.
The most dreaded complication of open fracture is osteomyelitis. Once established, osteomyelitis may result in months or years of pain, disability, medical therapy, surgical procedures, and ultimately amputation. Although osteomyelitis may be unavoidable in some cases, it becomes less likely when treatment is prompt and meticulous.
Open fractures are sometimes classified by severity, based on the length of the overlying laceration, extent of tissue damage, kinetic energy of the injuring force, and evidence or likelihood of significant contamination. Irrespective of these factors, any open fracture should be promptly and carefully treated. Elements in the care of open fractures are described later in this chapter.
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