An open fracture, also known as a compound fracture, means that a broken bone or cartilage has broken through the skin or that the skin has been damaged during injury. The protrusion of bone to elements in the air, dirt, or other materials greatly increases the chance of infection or disease in the bone. An open fracture must be treated by a medical professional immediately.
Open fractures occur when too much pressure is placed on the bone, usually during a fall, a car accident, during sporting activities, or because of a gunshot wound. Compound fractures can occur more easily if a person has osteoporosis because of brittle bones, and children are more likely to sustain a fracture because their bones are softer during the developmental years. A fracture is categorized as open if the skin is damaged or the bone penetrates the skin, while closed fractures are contained within the skin and there is no risk of infection from environmental elements. Broken bones are classified by what bone was fractured, such as the tibia or femur, and how the fragments of bone are aligned. Types of fracture classifications include depressed, linear, spiral, or impacted.
Depending on how the injury occurred and if the accident caused dirt, gravel, dirty water, or other substances to contaminate the fracture, the bone and surrounding tissue will need to be cleaned during a procedure known as debridement. Surgery is almost always necessary for a patient with an open fracture. The patient will be put under anesthesia to thoroughly clean the bone, and bone fragments and shredded tissue will be removed during the procedure. Antibiotic fluids will be used to clean the area. A tetanus shot may also be administered to prevent disease.
To allow the bone to heal back together, the bone will be put back into place, sometimes with screws, nails, or plates, and a cast or splint will be worn by the patient to provide stability and to immobilize the bone during the healing process. Internal nails will sometimes be fixed to an external frame to prevent movement. A fracture will usually heal within six weeks, but if there are complications or if the person is elderly, healing could take 12 weeks.
If an open fracture is not properly treated, an infection in the bone, also known as osteomyelitis, can occur. Multiple surgeries may be required to remove the infected tissue and bone as well as drain fluid. Depending on the severity of the infection, bone grafting may be completed to aid in the healing process. If these steps are not taken, the bone may heal deformed or the ends of the broken bone will not join during the healing process.