Compound Fracture Complications and Treatment

Compound Fracture

• If the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called as compound fracture.
• For example, when a pedestrian is struck by the bumper of a moving car, the broken shinbone may protrude through a tear in the skin and other soft tissues.
• Since compound fractures ofteninvolve more damage to the surrounding muscles, tendons, and ligaments,they have a higher risk for complications and take a longer time to heal.
• This type of fracture is particularly serious because once the skin is broken, infection in both the wound and the bone can occur.

• Type I: Wound is smaller than 1 cm, clean and generally caused by fractured fragment which pierces the skin. This is a low energy injury.
• Type II: Wound is longer than 1 cm, not contaminated and is without major soft tissue damage or defect. It is also a low energy injury.
• Type III: Wound is longer than 1 cm with signifiant soft tissue disruption. Mechanism involves high energy trauma,resulting in severe unstable fracture with varying degrees of fragmentation.
• Type IIIA: Wound has suffient soft tissue to cover the bone without need for local or distant flp coverage.
• Type IIIB: Disruption of soft tissue is extensive such as local or distant flp coverage is necessary to cover the bone. Wound may be contaminated, serial irrigation and debridement procedures are necessary to ensure clean surgical wound.
• Type III C: Any open fracture associated with an arterial injury requires repair is considered as Type IIIC.

“External Fixation For Compound Fractures“

Compound Fracture Etiology

• Compound fractures are caused by high-energy trauma, most commonly from a direct blow, such as from a fall or motor vehicle collision.
• These fractures can also occur indirectly, such as a highenergy twisting type of injury.

Compound fracture Management

• X-rays will show how complex the fracture is.
• Routine blood and urine tests provide information about the general health.

Compound Fracture Treatment

• Antibiotics are started as soon as possible in the emergency room.
  Severity of injury determines which antibiotics are given. Tetanus shot should be given.
  Cefazolin /clindamy cin is given the Type I and Type II open fractures while for type III fractures aminoglycoside is given.
• Injury will be covered with a sterile dressing.
  Doctor will gently put the bones back into alignment to prevent the fragments from causing further damage to soft tissues.
• Then splint should be applied to injured limb to protect it and keep it from moving until patient is taken to surgery.
• Débridement: During this procedure, surgeon will remove all dirt and foreign bodes, 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 unattched pieces of bone are removed.
  Severely contaminated bone fragments are also discarded. This bone loss can be corrected later with additional surgeries.
• Irrigation. After débridement, the wound is cleansed and irrigated with several liters of saline.
• It is important to stabilize the broken bones as soon as possible to prevent further soft tissue damage.
  The broken bones in an open fracture are typically held in place using external or internal fixation methods.
  These methods require surgery.
• For type II and type III compound fractures, serial irrigation and debridement is done till clean surgical wound is achieved.

• 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.
• Because open fractures may include tissue damage and be accompanied by additional injuries, it may take time before internal fiation surgery can be safely performed.

• In external fiation, 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.
• As fiation gets completed the skin should be sutured.
• In complex wounds, flaps should be place to cover the injury.

“Surgical Treatment For Compound Fractures”

Compound Fracture Complications

• Infection is the most common complication of open fractures. Infection can occur early, during the healing phase of the fracture, or even later.
  • In general, the greater the extent of soft tissue damage, the greater the risk for infection.
  • If an infection becomes chronic (osteomyelitis), it may lead to further surgeries and amputation.
• Compound fractures may have difficulty healing. If your fracture is failing to heal, further surgery may be required.
  • Surgery to promote healing usually includes placing a bone graft over the fracture, as well as new internal fixation components.

“Antibiotics For Compound Fracture Infections“

• Acute compartment syndrome may develop.
  • This is a painful condition that occurs when pressure within the muscles builds to dangerous levels.
  • Unless the pressure is relieved quickly, permanent disability and tissue death may result.