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Open bone fractures are a type of fracture in which the continuity of the bone tissue is broken and the skin is broken by the bone at the same time. The first aid provider should first cover the wound with a sterile dressing and bandage. It is also worth considering stiffening the limb to reduce the mobility of the joints adjacent to the broken bone. In addition, it is necessary to call an ambulance to the victim with an open fracture or take him to the hospital by himself, if possible. Find out more about open fractures in our article.
Types of fractures
A bone fracture is a break in the continuity of bone tissue. Such damage can occur as a result of mechanical force or it can be the result of diseases that damage bone tissue. Broken bones are very common injuries of both upper and lower limbs. The basic division of fractures is the division into open and closed fractures. It should be remembered that each of them requires a different procedure, and may also cause minor or major damage to other tissues.
Open fracture – characteristics
An open fracture consists in the fact that, in addition to breaking the continuity of bone tissues, the skin is also torn apart by damaged bone fragments. The broken bone is then visible and protrudes outward. Unfortunately, other tissues, such as muscles, blood vessels or nerves, are also most often damaged.
In very difficult cases of open fractures, there are also bone fragments, which may additionally pose a threat to the victim and may cause serious complications. Open fractures of the arms or legs occur most often as a result of traffic accidents, accidents at work or playing sports. It should be remembered that during an open fracture, severe hemorrhage, sensory disturbances and even a fat embolism may occur.
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Open fractures – division
Open fractures can be divided into different types depending on the degree of soft tissue damage. According to this criterion, we can distinguish:
- open fracture with slight skin damage — do 1 cm;
- open fracture with skin damage greater than 1 cm, but less than 10 cm – what is important, the fracture does not have scalp wounds and other damage to important blood vessels and nerves, no avulsive damage;
- open fracture with massive damage to soft tissues and bones – however, there is a possibility of primary tissue coverage;
- open fracture with massive damage to soft tissues – however, there is no possibility of primary coverage with soft tissues, which requires tissue reconstruction;
- open fracture with damage to the neurovascular bundlesthat requires reconstruction.
During an open fracture, the bone is most often visible and there is swelling in the surrounding tissues. It is associated with a lot of bleeding and severe pain. The risk of systemic infection is also much greater, which is why it is so important to provide first aid quickly and properly.
Open fracture – symptoms
The difference between an open and a closed fracture is the breaking of the skin in the case of an open fracture. However, what is important, the bone or its fragments are not always visible at the place where the skin is broken. That is why it is worth knowing the symptoms of an open fracture, including:
- severe pain and rapidly increasing swelling at the site of the injury;
- limited mobility of the limb or its abnormal range of motion;
- bone fragments or a fragment of damaged bone may be visible in the wound.
If the doctor has doubts about the diagnosis, he always takes the worst-case scenario, i.e. the fracture, and starts the appropriate procedure.
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Open fracture – threats
An open fracture can always be a life-threatening injury. The most common complication of an open fracture is very high blood loss, which is a consequence of blood vessel damage. If the haemorrhage is not stopped, it can lead to shock and death. Statistically, in the event of a femoral fracture, blood loss will be at least 1,5 liters, and in the event of an open fracture, it may be up to several liters of blood.
To others serious complications of open fractures these include nerve damage, sensory disturbances, paresis or paralysis of the muscles which are associated with the displacement of bone fragments. In addition, as you know, each open wound can be a source of infections, so it should be quickly protected against pathogens.
Open fracture – first aid
An open fracture requires immediate first aid. It is very important and should be performed properly to avoid serious complications of an open fracture. Improperly performed first aid also increases the risk of further damage. First, an open fracture should be secured at the scene of the incident, which reduces the risk of dangerous consequences of an open fracture and prepare the casualty for transport to hospital. Remember not to set an open fracture under any circumstances, nor touch the wound or force it on the limb of movement.
However, if a hemorrhage occurs, a sterile dressing will be needed, which should be applied to the site of the bleeding and bandaged quite tightly. In the case of an open fracture it is quite problematic because it is very painful, while stopping the bleeding requires pressure. Therefore, there is one rule, do not bandage the open fracture site tightly. So you have to find the so-called the Golden mean. The pressure should be strong enough to stop the flow of blood.
In addition, this sterile gauze will create a protective barrier on the wound, preventing the penetration of dangerous microorganisms into the wound, and additionally stabilize the fracture site. First aid in the case of an open fracture also includes immobilization of the fracture site. This should be done with a board or a stiff stick placed in such a way as to impede the mobility of the two adjacent joints.
This minimizes the risk of further damage during transportation of the casualty to the hospital or while waiting for an ambulance. Avoid unnecessary movements, therefore, for example, if an arm is broken, it should be bandaged together with the torso, and in the case of a leg, it should be immobilized, e.g. by bandaging with the other leg.
It should also be remembered that if there is a fracture of the shaft of the bone, always immobilize two adjacent joints, and if the fractures occurred around a joint, both bones forming the joint should be immobilized. Literally anything you can do to immobilize the fracture can be used to immobilize it.
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Open fracture – treatment
When the casualty is admitted to the hospital with an open fracture, blood tests are ordered. Performs include blood group, hematocrit, electrolytes, hemoglobin, and gasometry. Treatment of an open fracture begins with the diagnosis of the fracture with an X-ray image, which enables the assessment of the extent of damage, as well as the presence of any bone fragments in the wound and the degree of bone displacement.
When we are dealing with severe damage that may be life-threatening, the need to amputate the damaged limb, correctly position the bone in the limb, or stabilize the fragments, then a surgical procedure is performed.
Operations are most often performed with the help of the so-called Kirsehner wireswhich make it possible to stabilize the fragments and thus increase the chances of proper healing and the course of osteogenesis. These procedures are most often performed in patients with an open leg fracture (mainly the knee and ankle). They are also recommended for open finger or hand fractures.
After the open fracture is closed, an immobilizing dressing, i.e. plaster or splints, is placed over the sutured wound. The patient also receives antibiotics with a wide range of action, as well as various painkillers, anticoagulants, and preparations that improve arterial and venous circulation. The time of wearing the dressing and how much time the patient spends in the hospital is a very individual matter. It all depends, among others on how extensive the fracture was and how quickly it heals.
The period of healing of an open fracture lasts a minimum of 4 weeks. The method of first aid has a great influence on this. During healing, regular visits are necessary, as there may be complications in the form of sensory disturbances, problems with proper blood supply to tissues, or destabilization of bone fragments. For this reason, you should observe the healing area in time to catch any disturbing symptoms, such as bruising, forced finger restraint, fever or swelling.
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Open fracture – rehabilitation
Open fracture rehabilitation can be started while wearing the cast. It is then possible to use various treatments without the need to expose the injury site. These treatments will have no problems affecting deep tissues. Magnetic therapy is one of the rehabilitation procedures after an open fracture. This treatment enables the acceleration of the process of osification and tissue healing, and additionally, it can be performed despite the presence of metals in the wound.
When the healing process allows it, it is possible to start anti-swelling prophylaxis by moving the broken limb up and down for a few minutes. In this way, we pump blood, which improves circulation and prevents stagnation. Regardless of the type of fracture, our ability to locate is severely limited, therefore such procedures should be introduced.
It is enough to hold the limb for 20 minutes a day above the level of the body, which has a positive effect on reducing the risk of swelling, and the more often we repeat this activity, the better. In addition, if a patient complains of pain, they should be given painkillers. Other procedures can be performed only after removing the dressings and protruding metal elements.
These include pinotherapy, post-isometric relaxation, kinesiotaping, self-massage. The auto-massage treatment can be performed at home after obtaining the consent of the doctor. It consists in stroking, rubbing and tapping the fracture site. In addition, to stimulate circulation, it is also worth pouring hot and cold water over the place for a while. Massage with materials of various structures, such as sponges or rough gloves, will also be beneficial.
Physiotherapy will also be necessary, during which patients with open leg fractures will work with their doctor on the correct gait pattern, minimize contractures, improve proprioception, and even reduce the visibility of scars. Physiotherapy therefore includes many different manual procedures.
Rehabilitation after open fractures takes a long time and you should be patient. Strict adherence to doctors’ recommendations has a great influence on the effects.