Trends in the Management of Open Fractures

One hundred and fifty years ago, mortality was common following open fracture. With the advent of modern therapy, however, the expected outcome has improved dramatically. In the treatment of open fractures, the surgeon’s objectives are to prevent infection, promote fracture-healing, and restore function. All patients presenting with an open fracture require initial stabilization, tetanus prophylaxis, systemic antibiotic therapy, prompt surgical débridement and copious irrigation, fracture stabilization, timely wound closure, thorough rehabilitation, and adequate follow-up. In addition, certain patients may benefit from local antibiotic therapy, open wound management (possibly including vacuum-assisted closure), flap closure, bone-grafting, or other adjunctive therapies. In this review, we analyze the evidence concerning a number of important issues in the management of open fractures, including classification, use of antibiotics, timing of operative intervention, irrigation, fixation, soft-tissue coverage, and adjunctive therapies.