Management of open fractures: part 1

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Open fractures have been considered one of the true orthopaedic emergencies by some, however optimal treatment has not been definitively described. Significant debate has focused on the most appropriate method by which to manage open fractures, but general principles of treatment are well established. Principles include fracture classification, antibiosis, irrigation, debridement, wound management and fracture stabilisation. In this first of a two-part series on open fracture management, the initial management of the patient, which should be performed within the first few hours after presentation, is discussed. This includes assessment and stabilisation of the patient, classification of the fracture, antibiotic use and irrigation of the wound. Open fracture classification systems, such as the Gustilo-Anderson scheme, are used to describe the relationship and degree of soft tissue damage, and are designed to correlate with treatment guidelines and prognosis. Systemic antibiotics are a required component of successful treatment, and prompt initiation of these is important. Irrigation is a key component of the effort to prevent infection, and this should be performed using saline solution and low-pressure methods routinely. The remaining principles (debridement, wound management and fracture stabilisation) will be explored in the second article in this series.