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Open Fractures
An open bone fracture is a serious injury. It means that the fractured bone has penetrated the skin to some degree. These injuries generally occur as a result of high-energy trauma such as car crashes, falls, or sporting activities.
Types of Open Fractures
According to the Gustillo–Anderson Classification, there are three types of open fractures.
- Type I is a low-energy clean wound that is usually less than 1 cm in length with minimal soft tissue injury and minimal bone comminution.
- Type II describes a wound length of 2 – 10 cm with moderate soft tissue damage and wound contamination.
- Type III describes a high-energy wound usually greater that 10 cm in length with extensive muscle devitalization. The wound is highly contaminated with extensive soft tissue damage. Type II fractures can also include open segmental fragments.
Type III fractures are further classified into Type IIIA, B and C.
- In a Type IIIA open fracture there is severe soft tissue damage, although coverage of the bone is possible.
- In a Type IIIB fracture, there is severe loss of soft tissue. Bone coverage is not possible. There may be moderate to severe bone comminution. This injury usually requires a local or distant flap.
- Type IIIC fracture describes an open fracture with a vascular injury requiring repair or amputation. Amputation is required if there is extensive vascular injury, muscle and tissue ischemia for more than 8 hours, no plantar sensation due to posterior tibial nerve injury, or based on a Mangled Extremity Severity score.
Treatment
The goals of treatment for open fractures are to prevent infection, get the broken bones to heal, and restore function.
- Antibiotics and Tetanus: Antibiotics are started as soon as possible in the emergency room. The severity of the injury determines which antibiotics are given. A tetanus shot will be given if a booster was not had within 5 years of the injury.
- Injury Stabilization: The injury will be covered with a sterile dressing. The doctor will gently put the bones back into alignment to prevent the fragments from causing further damage to soft tissues. Then the doctor will apply a splint to protect it from moving until surgery can be performed.
Débridement and irrigation will be performed to prevent infection. The surgeon will remove all dirt and foreign bodies, as well as any contaminated and unhealthy skin, muscle, and other soft tissues. The bone is also cleaned of all dirt and other foreign material. Any unattached pieces of bone are removed. Severely contaminated bone fragments are also discarded.
During the operation, the bone fragments are first repositioned (reduced) into their normal alignment and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone. These methods of treatment can reposition the fracture fragments very exactly.
Depending on the injury, the doctor may use external fixation to hold the bones in general alignment. This is where pins or screws are placed into the broken bone above and below the fracture site. Then the orthopedic surgeon repositions the bone fragments. The pins or screws are connected to a metal bar or bars outside the skin. This device is a stabilizing frame that holds the bones in the proper position.
More severe open fractures are typically first stabilized using external fixation. This treatment will keep the bones in place until the wound can tolerate an internal fixation.
Depending upon the amount of soft tissue lost, these complex wounds can be covered using different methods.
A local flap is where the muscle tissue from the involved limb is rotated to cover the fracture. A patch of skin taken from another area of the body (graft) is placed over this.
A free flap is where tissue is often taken from the back or abdomen to be grafted over the wound.
New York City Open Fracture Attorneys
Mr. DiMartini is a veteran New York City personal injury attorney. For decades he has been assisting people injured in accidents throughout the New York metropolitan area. He knows you are concerned for the future and have questions. He has the answers.
When you call our office, you will speak with Mr. DiMartini directly about your claim. He takes pride in being there for people in their time of need. He will discuss your case with you and advise you of what he believes are your best options. If you were harmed due to the negligence of another party, he will seek to get you the most compensation you deserve for your accident-related injuries. He has recovered millions of dollars in compensation for his injured clients.
If you or a loved one has sustained an open bone fracture in a New York accident, we are here to fight for your rights.
Personal injury litigation is all we do. We get results!
