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24 - Open Fractures

from Part I - Systems

Published online by Cambridge University Press:  15 December 2009

Melinda Sharkey
Affiliation:
Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Serena S. Hu
Affiliation:
Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

Open fractures occur when the involved bone and surrounding soft tissues communicate with the outside environment because of a traumatic break in the overlying skin. Many open fractures are a result of high-energy trauma and are associated with severe soft-tissue injury. Lower energy open fractures occur when the skin break is caused by an “inside-out” injury. This occurs when a fractured end of the bone penetrates the overlying skin.

EPIDEMIOLOGY

Fractures represent a major public health problem. The lifetime risk of fracture up to age 65 years is one in two, and every year, 1 in 118 people younger than 65 years of age sustains a fracture. Approximately 2% of all fractures and dislocations are open.

CLINICAL FEATURES

Open fractures can be classified according to the Gustilo classification system (Figures 24.1, 24.2, and 24.3; Table 24.1).

DIFFERENTIAL DIAGNOSIS

Key clinical questions that may help in the diagnosis of open fractures are:

  • Is an open fracture the source of visible bleeding?

  • How large is the wound and how severe is the soft-tissue damage?

  • Are the joints above and below affected?

  • What is the neurovascular status of the affected limb?

TREATMENT AND PROPHYLAXIS

The rate of infection despite antibiotic administration in type I fractures range from 0% to 2%, in type II fractures from 2% to 10%, and in type III fractures from 10% to 50%.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Gustilo, R B, Anderson, J T. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg 1976;58-A:453–8.CrossRefGoogle Scholar
Gustilo, R B, Mendoza, R M, Williams, D N. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;24:742–6.CrossRefGoogle ScholarPubMed
Patzakis, M J, Harvey, J P, Ivler, D. The role of antibiotics in the management of open fractures. J Bone Joint Surg 1974;56-A:532–41.CrossRefGoogle Scholar
Patzakis, M P, Wilkins, J.Factors influencing infection rate in open fracture wounds. Clin Orthop 1989;243:36–40.Google Scholar
Zalavras, C G, Patzakis, M J. Open fractures: evaluation and management. J Am Acad Orthop Surg 2003;11:212–9.CrossRefGoogle ScholarPubMed

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  • Open Fractures
    • By Melinda Sharkey, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Serena S. Hu, Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.025
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  • Open Fractures
    • By Melinda Sharkey, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Serena S. Hu, Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.025
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Open Fractures
    • By Melinda Sharkey, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Serena S. Hu, Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.025
Available formats
×