Management of open fractures: A narrative review

• Published in: Journal of clinical orthopaedics and trauma 2023-09, Vol.44, p.102246, Article 102246
• Main Authors: Jayaramaraju, Dheenadhayalan, Vasudeva, Nagashree, Devendra, Agraharam, Sundaram, Velmurugesan Purnaganapathi, Rajasekaran, Shanmuganathan
• Format: Article
• Language: English
• Subjects: Debridement; Ganga hospital open injury severity score; General Orthopaedics and Others; Open fractures; Orthoplastic approach; Wound irrigation
• ISSN: 0976-5662; 2213-3445
• DOI: 10.1016/j.jcot.2023.102246

Open fractures are an emergency where the principal aim of the treatment is to maximise the restoration of limb function while preventing the dreaded consequences of infection and non-union. The decision-making process for open injuries is influenced by a variety of criteria, such as patient age, injury features, systemic response, activity level, comorbidities, and functional requirements. A collaborative orthoplastic approach to treating these injuries is essential for minimizing complications and need to be considered as a single specialty in early and long-term management. It has been shown that early prophylactic systemic antibiotics, wound irrigation, aggressive debridement of contaminated and devitalized tissue, and appropriate fracture fixation decreases the complications in all grades of open fractures. The advantages of Gram-negative antibiotics, the use of local antibiotics, intraoperative wound cultures, the "fix and flap" approach, and Negative Pressure Wound Therapy are few of the treatment options that are still controversial. The aim of this review is to provide a comprehensive review and practice guidelines regarding the management of open fractures.