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The management of open fractures has changed significantly in the era of managed care, and traditional methods of limb salvage are being more critically evaluated. The orthopedic surgeon is in a position of delivering emergent and decisive care while taking into consideration the recent advances in technology and long-term consequences. When considering the individual needs of the patient and reconstruction, we should focus on long-term results, quality of life, and open fracture or compound fracture.
Evaluation of soft tissues is necessary for both closed and open fractures. The severity of the soft tissue injury thus helps determine the timing of surgical intervention, type of fixation, and prognosis.
To achieve good outcomes, it is important to treat the open fracture initially at the scene.
All open fractures must be classified early. The primary classification divides the fracture into "closed" or "open." It is from this simple classification that the noncomprehensive classifications.
Gustillo and Anderson also devised a three-grade classification based on an analysis of 1000 fractures. They divided these into type 1: fractures less than 1 cm and clean; type 2: extensive soft tissue damage with an opening.
One of the most difficult circumstances in severe injuries is to decide whether amputation is necessary. Years ago surgeons made the choice of amputation or an attempt at limb salvage based on initial clinical evaluation, impression, and experience in treating these types of injuries. A series of indices and scores has been developed to evaluate.
Once the extremity has been evaluated, a decision must be made about whether or not to attempt to save the limb. The patient should then be taken to the OR as quickly as possible. Operative treatment is dictated by the severity of the soft tissue injury and the fracture pattern. Wound debridement is not necessary for grade 1 open fractures.
Living tissue offers the best defense against infection, and removal of necrotic tissue is imperative. After the wound has been satisfactorily debrided, attention should then be turned toward treating the fracture.
In selecting the type of implant to use, multiple factors should be considered. The surgeon should always use the least amount of implant to achieve the goal of rigid fracture fixation. Depending on the location of the fracture.
Another variable for successful treatment is antibiotic therapy. Initially the patient should be protected with tetanus prophylaxis.