Changing paradigms in the management of Open Injuries

Background The definition of an open fracture where the fracture and the hematoma communicate with the external environment is well known. But the treating surgeon should also be aware that the skin defect may not lie directly under the fracture site and may communicate with the fracture under degloved skin. Hence any fracture with a wound in the same region should be considered an open injury until proven otherwise by exploration. Open injuries – often high-velocity injuriesare frequently associated with higher risk of complications including amputation [1,2,3,4]. The present challenge to the trauma surgeon is not simply to salvage the injured limb but also provide a good functional outcome. The principles of management of open injuries have evolved with time and today with advances in both orthopaedic and plastic surgery, the management is now in the ‘Era of functional restoration’. Surgeons have now realised that success of open injury management is not merely salvage and one should not succumb to the ‘triumph of technique over reason’. The paradigm has now shifted to restoring a good functional outcome to the injured patient and also focusing on developing safe protocols of bone and soft tissue reconstruction5. In this article, we discuss the important recommended practices which are determinant of a good outcome in open injury management.