Classification used for open fracture
Important for prognosis
Based on 5 criteria
1. Size of the wound
2. Degree of contamination -
3. Degree of comminution - simple vs. comminuted
4. Soft tissue injury - mild, moderate, severe
5. Level of energy
Type | Size of the wound | Degree of contamination | Degree of comminution | Soft tissue injury | Level of Energy |
1 | <1cm | Clean | Simple # | Mild | Low |
2 | 1-10cm | Moderate | Simple # | Moderate | Moderate |
3 | >10cm | Dirty | Comminuted # | Extensive | High |
3a | Adequate soft tissue coverage | ||||
3b | Extensive soft tissue lost with periosteal stripping and bony exposure | ||||
3c | Major arterial injury requiring repair for limb salvage |
Principle of Management for Open Fracture
1. Management of wound
2. Management of fracture
Management of wound
i. Wound irrigation (to dilute microorganism)
ii. Antibiotics
| Type of Fractures | Empirical antibiotics |
| 1 | IV cloxacillin IV gentamycin |
| 2 | IV cloxacillin IV gentamycin OR IV cefuroxime |
| 3 | IV cefuroxime IV gentamycin IV metronidazole |
iii. Analgesic
iv. Wound debridement
Management of fracture
i. Reduction - open
ii. Immobalise - external vs. internal
External - cast, splinting, external fixator, illizarov
Internal - intamedullary vs. extramedullary
Extramedullary - K-wire, screw fixation, plating, tension band wire, circlage wire
Intramedullary - interlocking nail
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