Why are compound fractures of significance?

A compound or open fracture is important as it signifies a greater degree of soft-tissue damage that needs urgent assessment and may require reconstructive surgery in the future. A compound fracture has a much greater risk of complications such as infection, delayed or non-union.

What is the initial management of a patient with a compound fracture?

Many patients with compound fractures also have significant other injuries and maybe in shock. A thorough advanced trauma life support assessment to identify and correct any life-threatening injuries should be the first step. Other specific measures include:

• Assessment and documentation of the wound. Ideally a photograph should be taken, the wound covered with a sterile dressing and left undisturbed until the patient is in theatre. A wound swab may be taken prior to dressing.

• Assessment and documentation of the neuro-vascular status of the limb.

• Intravenous prophylaxis antibiotics.

• Tetanus prophylaxis.

• Analgesia.

• Splintage of the affected limb (Thomas' splint, Plaster of Paris, etc.).

• Radiographs of the limb and the surrounding joints are obtained in two views.

Describe Gustilo's classification of open fractures

• Type I Small, clean, puncture wound (<1 cm) as a result of a low energy injury with little soft-tissue damage

• Type II The wound is >1 cm but again the degree of soft-tissue damage is low

• Type III These are as the result of high-energy trauma with extensive soft-tissue damage and contamination:

• Type IIIA adequate bony cover can be achieved

• Type IIIB there is comminution, periosteal stripping and bone loss and the wound is heavily contaminated

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