Open Fractures

• Fracture are classified as either open or compound when there is a break in the overlying skin
• Open fractures are prone to infection and the risk of infection increases with the size of the wound and also with the time interval between the time of the injury actually happening and treatment being recieved.

Open Fracture classifiction

These are classified according to the Gustillo classification :

• Type 1 - the wound is usually a small clean puncture less than 1 cm in length. There is little soft tissue damage with no fracture comminution
• Type 2 - the wound is greater than 1-2 cm in length long and there is no extensive skin damage. There is not much soft tissue damage but the fracture is comminuted
• Type 3 - there is extensive damage to the skin, soft tissue and neurovascular structures with considerable contamination of the wound. There are three subdivisions of Type 3 open fractures:
  • Type 3a - the fractured bone is covered by soft tissue
  • Type 3b - the fracture bone is not covered by soft tissue as a result of extensive soft tissue loss and there is evidence of periosteal stripping
  • Type 3c - there is disruption to the vascular supply requiring surgery.

Figure 1 - Open Fractures

                        Gustillo Classification - Type 1                                                                  Gustillo Classification - Type 3b

Management of Open Fractures