Open Fracture Characteristics and Management

Written by: Alex Chen, OMS-II

Open fractures are one of the most serious orthopedic injuries, often resulting in long-term complications. It’s important to understand what makes an open fracture unique from closed ones, along with its severity level and how it should be managed for optimal recovery. 

In this blog post, we will look at why open fractures are so serious and the types of treatment available. 

At OrthoNeuro, we help many patients successfully recover from open fractures. Contact us in Columbus, Ohio for expert orthopedic care today!

What is an Open Fracture?

An open fracture, also known as a compound fracture, is a fracture where there is a break in the skin caused by the broken bone. Oftentimes, this is due to a fragment of the bone piercing through the skin at the time of injury. In some instances, compound fractures may include the bone being visible or protruding through the wound. 

Surgeons at OrthoNeuro treating a patient with an open fracture.

These injuries have complications that may not be associated with simple, or closed, fractures where the skin has not been pierced by the bone. 

For example, there is an increased risk of infection with an open fracture as a result of the open wound. As such, the treatment for these fractures may be very different from the typical casting you are used to seeing.

What Causes an Open Fracture?

Open fractures are often due to a high-energy accident or trauma. This may be from something as severe as a car crash or simple as an injury from sports. It may also be caused by repeated stress on the bone, rather than a high-impact injury. 

Open fractures typically occur in your limbs, but may also occur with other fractures, such as that of your collarbone. Regardless of the mechanism of injury, the defining characteristic of an open fracture is one in which the bone pierces the skin, creating an open wound.

Why Are Open Fractures Dangerous?

One reason open fractures are dangerous is due to the risk of infection. With the open-wound nature of an open fracture, patients are at risk of contamination and potential infection. Depending on the mechanism of injury, things such as dirt, glass, etc., can seed the wound and potentially lead to subsequent infection. 

Infections are extremely dangerous, especially if they are able to seed the bone. Infections of the bone, also called osteomyelitis, are complex conditions that require additional surgeries and antibiotics. 

Open fractures also pose the risk of damage to nearby structures such as muscles, tendons, ligaments, nerves, and vasculature such as arteries and veins. Depending upon the location of the fracture and fracture pattern, compound fractures may indirectly affect surrounding tissues, causing further complications. 

Fractures affecting nerves can potentially cause neuropathic pain, which can take significantly longer to resolve. Fractures affecting major blood vessels can lead to severe blood loss and potentially be life-threatening if not treated in a timely manner. 

Additionally, adequate blood supply is crucial for healing of the fractured bone. With inadequate blood supply, it is possible for the fracture to have either delayed healing or failure of healing, also known as non-union. In such instances, additional surgery may be necessary to assist in and promote the healing process.

Open fractures may also lead to a condition called compartment syndrome, where the pressure in the injured body part rises significantly. Compartment syndrome can cause severe pain as well as further damage to muscles and nerves due to decreased blood flow. If not treated emergently, compartment syndrome can cause permanent damage.

What Are the Symptoms of an Open Fracture?

Symptoms of an open fracture include a break in the skin, sharp pain, tenderness to touch, swelling, and bruising. Additionally, if a nerve is affected, you might experience feelings of burning, numbness, or tingling. Depending upon the severity of the injury, you may also see your bone through the wound.

How Are Open Fractures Treated?

Open fractures are initially evaluated and treated in the emergency department. During this time, the emergency room physician will obtain a history of the injury, order x-rays to determine the extent of injury, provide antibiotics for infection prevention, and provide temporary injury stabilization until you are able to be seen by a surgeon. You will also be provided a tetanus booster if yours is not up to date.

Open fractures almost always require surgery. Prevention of infection is crucial in the treatment of a compound fracture, so it is extremely important for you to go to surgery as soon as possible. 

The first step of the surgery would be a debridement and irrigation in which the surgeon will remove any foreign materials and damaged tissues from the injury site. The wound is then irrigated, or cleaned, to ensure that all potential causes of infection are removed. 

Once the wound is cleaned, the surgeon will move on to reducing the fracture, or setting the bones in place.

Open fracture reduction often requires a procedure called Internal Fixation. In this procedure, the surgeon will return the bone fragments to their original position and then secure them using a combination of plates, screws, rods, and pins. These may be placed either on the outside of the bone or inside the canal of the bone. 

These implants will hold the broken bones in place while the fractures heal and new bone is formed. After the surgery is completed, the surgeon will place the affected body part in a cast or other immobilizer. You will also be given additional antibiotics to continue in the prevention of infection.

Key Takeaways

Open fractures are complicated injuries that require medical attention. If you experience an open fracture, it is important that you are seen in the nearest emergency department so that you can be evaluated and a treatment plan started. Your treatment plan will likely require surgery, which will be further discussed between you and your surgeon.

Book Your Appointment

Contact OrthoNeuro for expert orthopedic help. Our orthopedic surgeons have helped many people successfully recover from bone fractures. We have many offices throughout Columbus, Ohio. Book your visit now!


Medically Reviewed by Mark Gittins, DO

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