Le fratture esposte articolari e periarticolari

Abstract

Exposed articular and periarticular fractures are serious injuries, often resulting from high-energy traumas, associated to high risk of septic complications, functional impairment of the affected limb and not infrequently patient’s life threatening conditions. Their incidence, though low, is however increasing. The patient with exposed fracture presents an associated injury up to one third of cases. The initial evaluation plays a fundamental role both in the identification and treatment of any concomitant injuries, and in the choice of strategy and timing of treatment of the exposed fractures. The presence of a plastic surgeon in the team facilitates the definition of the therapeutic path. The debridement of the lesion is a fundamental time and must be accurate. Stabilization with external fixator is certainly the treatment of choice and can be adopted both as temporary or as a definitive fixation. Soft tissue management is the keystone of the therapeutic pathway of exposed articular and periarticular fractures. The progress made in “orthoplasty” encourages acute internal fixation and immediate coverage—fix and flap, with a significant reduction in infectious risks and improvement of prognosis. In any case, the available evidence about the treatment of these injuries is limited. Proper management requires a multidisciplinary approach, great experience and personalization of the therapeutic path.