Open Versus Closed Fractures?

Depending upon cause and pattern in which the bone breaks, fractures have been classified into different categories. Not only this helps physicians to communicate better but also to plan the treatment and gauge the prognosis. Today we would discuss open and closed fractures.

Fractures could be either closed fractures or open fractures. These were previously called simple or compound fractures.

A simple fracture by definition, is the one where the fracture hematoma does not communicate with the surroundings.

What does that mean?

It means that the blood that is collected after the fracture is collected in the closed space formed by tissues around the bone and is not communicating with external environment. But if the same fracture is accompanied by a external wound which is continuous with the fracture hematoma (means the fracture hematoma is no more closed, it can communicate to exterior now because the tissues surrounding have also been injured and allow a passage to be formed where blood can trickle to outside.

 

Open Fracture Femur With Bone Jutting Out

Open Fracture Femur With Bone Jutting Out

A mere presence of a wound does not make a fracture an open fracture. There should be some continuity between this wound and fracture inside. However, that needs a trained eye to differentiate between the two.

For all practical purposes, all fractures with a wound over the skin should be treated as open fractures, unless proved otherwise.

In a similar fashion, a fracture may also communicate with the internal cavity, such as abdomen. These are also called open fractures. It commonly happens in fracture of pelvic bones.

There are two ways in which a fracture might become open fracture. Either the trauma, usually high velocity may damage the external tissue that surrounds the bone and lay a path for communication. This commonly happens in missile injuries or high velocity trauma.

In other case, the spikes of broken bone may pierce the skin and other tissues from inside and lay a communication path.

A open fracture may have a wound size ranging from a pin prick to complete baring of the bone. Open injuries have been further classified according to their severity and helps the treating doctor to plan the treatment and measure the prognosis.

Do not get deceived by the size of the wound accompanying the fracture. All open injuries, whether a prick or bigger wound, by all means are surgical emergencies in contrast to closed where only a few are surgical emergencies and can be managed for sometime just by splinting.After providing primary splintage.

These patients should be rushed to nearby trauma center/ hospital where proper management can be done.

Remember! Earlier you take these patients to the hospital, better it would be for them.

Until there is a severe soft tissue loss, most of the open fractures have a fate that is almost equivalent to their closed counterparts. But because it is open, there would be increased chances of contamination and infection.

That is why they are the surgical emergencies.

Note:
Terms open and closed are also used in dislocations of the joint and impart similar meaning like open fractures and closed fractures,

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