![]() ![]() Subsequently, the effect of soft tissue injury on the consolidation of a fracture became more evident, and in 1976 Gustilo's classification into three types was proposed, which nowadays is widely used in Anglo-Saxon countries. b Clinical picture of the leg with exposure of the proximal part of the plate ![]() a X-ray of a tibial closed fracture with soft tissue damage treated by plating. During the same period Allgower's classification was also published, dividing injury into three grades according to the extent of soft tissue involvement. Anderson in 1971 proposed a classification into three types based on the extent of the skin lesion and the extent of contamination and necrosis of the wound. In 1957 Cauchoix presented a classification of open fractures into three types according to the extent of the cutaneous injury. In general, they are too complicated or too detailed, neglecting the trauma mechanism and considering only the anatomical structures that have been involved. It is of some interest, in this respect, to be reminded of the evolution of the classification systems for fractures. Skin lesions appear as excoriations, blister, sharp-edged injury (from stab wound), contused-edges injury (from stab wound and compression), suprafascial detachment, or necrosis muscular injuries can involve muscles or tendons and vascular injuries include arterial, venous, and lymphatic injuries.Ī careful evaluation of soft tissue involvement is mandatory in both exposed and closed fractures due to the fact that the extent and severity of the soft tissue involvement and its possible evolution represent the main criteria for prognosis and treatment (Fig. ![]() In each diaphyseal fracture both bone and surrounding soft tissues are involved, including the skin, the subcutaneous tissue, fascia, muscles, tendons, ligaments, periostium, vessels, and nerves. Johnson, MD, at 42 to assure the best care and follow-up for your open fracture or other orthopaedic injury.The difference between closed and open fractures is sometimes blurred and it is important to try and elucidate the real differences between them. Long recovery times might mean that you’ll suffer some muscle atrophy, and you could require physical therapy to regain full strength and mobility.Įvery open fracture has its challenges. Since open fractures usually result from severe trauma, recovery could be longer due to the severity of the injury. ![]() A similar fracture with an associated open wound may take an additional four to six weeks. A closed fracture to a bone may take three months to heal, for example. Open fractures typically take longer to heal than closed fractures, even if early treatment prevents infection. Johnson’s approval, repairs of the bone fracture begin. Irrigation flushes the wound with plenty of saline solution. This is the debridement phase, and it often requires an enlargement of the initial break in the skin. Johnson removes dirt, foreign objects, and damaged tissue from the wound, anything that could potentially contaminate the wound. This is where debridement and irrigation take place. In most cases, the initial treatment of an open fracture takes place in a sterile operating room. It’s the standard of care for open fractures to treat the injury first for the potential infection risk and then deal with the broken bone itself later. Your skin provides an essential barrier against bacteria and other contaminants, and a wound that penetrates the skin becomes a potentially serious entry point for infectious disease. Unlike a closed fracture, where the bone's condition is the primary concern, the treatment priority of an open fracture is the prevention of infection. Fractures of this type usually result from a high-impact event, such as a car accident or a gunshot wound, but they may also result from sports injuries or falls in rare cases. Treatment typically focuses on aligning, stabilizing, and immobilizing the broken bone.Īn open fracture breaks through the soft tissue surrounding the bone, including an open wound through the skin. This constitutes a closed, or simple fracture. When a bone breaks, the damage is often internal and invisible from the outside, unless there’s a severe deformation of your body at the break. Johnson is the right choice when you want comprehensive, informed treatment after a compound fracture. As an orthopaedic trauma surgeon, dealing with open fractures and the unique challenges they present is a regular part of his practice. While, in most cases, you’ll eventually be able to return to your former active lifestyle, much depends on how you heal and your attention to the details of recovery.Įric E. Your long-term prognosis depends on several factors surrounding the severity of your fracture. Broken bones are always serious, but when there’s damage to soft tissue around the bone break, called an open or compound fracture, the problems ahead of you multiply. ![]()
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