Open Fracture: Complications, Diagnosis, and Treatment

An open fracture is a serious injury that occurs when a bone breaks and the broken end protrudes through the skin, exposing it to the external environment. This puts the patient at a high risk of infection and other serious complications.

Complications of Open Fractures

1. Systemic complications:

• Trauma shock: Due to blood loss, pain, and shock.
• Fat embolism syndrome: Fat from the bone marrow is released into the bloodstream, traveling to the lungs and causing blood vessel blockages.
  • Stage 1: Fat from the bone marrow enters the circulatory system.
  • Stage 2: Fat droplets block the pulmonary capillaries.
  • Stage 3: Acute pulmonary inflammation.
• Acute renal failure: Due to decreased blood flow to the kidneys, causing toxin accumulation.
• Systemic hypoxia: Due to blood loss, lung injury, and respiratory failure.

2. Local complications:

• Compartment syndrome: Increased pressure within the muscle compartment, damaging tissue and obstructing blood flow.
• Vascular injury: The fracture can injure arteries, veins, causing bleeding and circulatory obstruction.
• Nerve injury: The fracture can damage nerves, causing paralysis, muscle weakness.
• Infection: Open wounds are easily infected by bacteria from the external environment.
• Malunion, delayed union, nonunion, and dysfunction: Due to severe injury, fractures may be difficult to heal, leading to deformities, limited mobility.

Diagnosis and Treatment

1. Diagnosis:

• Clinical examination: Inspecting the wound, identifying the fracture site, assessing motor function, and sensation.
• Radiographs (X-rays): Determining the location, extent, and type of fracture.
• Angiography: Assessing the condition of blood vessels and detecting blood vessel blockages.

2. Treatment:

a. Trauma shock management:

• Rapid fluid resuscitation: Replenishing fluids, electrolytes, maintaining blood pressure.
• Oxygen therapy: Supplying oxygen to the body.
• Hemorrhage control: Stopping bleeding, bandaging, immobilizing the fracture.
• Pain management: Anesthetizing the fracture site, using pain relievers.

b. Fat embolism syndrome management:

• Signs and symptoms:
  • 4 major signs:
    1. Subcutaneous bleeding, conjunctival hemorrhage.
    2. Neurological decline.
    3. Pulmonary edema: Difficulty breathing.
    4. PaO2 < 60mmHg.
  • 5 minor signs:
    1. Heart rate > 110 bpm.
    2. Retinal artery occlusion.
    3. Decreased hematocrit, reduced total red blood cell count.
    4. Lipuria (fat in urine).
    5. Fat droplets in sputum.
• Diagnosis: 1 major sign + 4 minor signs.
• Treatment:
  1. Continuous high-dose oxygen therapy.
  2. Hydrocortisol 100 mg/4-6 hours.
  3. Circulatory support for shock.

c. Compartment syndrome management:

• Diagnosis:
  • Compartment pressure > 30 mmHg (normal 0-5mmHg).
  • Diastolic blood pressure < 30mmHg.
• Treatment: Fasciotomy (surgical incision to relieve pressure).
  • < 6 hours: Conservative management.
  • 6-15 hours: Immediate surgery.
  • > 15 hours: Surgical decompression/amputation.

d. Vascular injury management:

• Indications for angiography:
  1. Knee dislocation + ABI < 0.9.
  2. Cold, cyanotic foot.
  3. High-force injury.
• Treatment: Surgical repair of blood vessels, stenting, embolization of blood vessels.

e. Open fracture management:

• Wound irrigation: Using normal saline, clean water.
  • Type 1: Irrigate 3 times.
  • Type 2: Irrigate 6 times.
  • Type 3: Irrigate 9 times.
• Antisepsis:
  • Type I, II: Cephalosporin I, II/Quinolone.
  • Type III: Add Aminoglycoside.
  • Adults: 1g cephazolin/gentamicin.
  • Risk of fecal/soil contamination: Clostridium => Penicillin.

f. Pain management:

• Pain relievers:
  • Opiates: Morphine, Dolargan.
  • NSAIDs.
• Regional nerve block: Novocain 25%.

g. Fracture immobilization:

• Bandages, splints, traction.
• Surgery: Reduction, fracture fixation with splints, screws, plates.

Note:

• Open fracture treatment should be performed by specialized physicians.
• Strictly follow the doctor’s instructions regarding wound care, medications, and nutrition.
• Monitor your health closely after surgery, detect complications early for prompt treatment.

In conclusion, open fractures are serious injuries requiring timely and professional management. Understanding the complications and treatment steps is crucial for optimal recovery after injury.