Open fractures: evaluation and management.

Open fractures are complex injuries that involve both the bone and surrounding soft tissues. Management goals are prevention of infection, union of the fracture, and restoration of function. Achievement of these goals requires a careful approach based on detailed assessment of the patient and injury. The classification of open fractures is based on type of fracture, associated soft-tissue injury, and bacterial contamination present. Tetanus prophylaxis and intravenous antibiotics should be administered immediately. Local antibiotic administration is a useful adjunct. The open fracture wound should be thoroughly irrigated and debrided, although the optimal method of irrigation remains uncertain. Controversy also exists regarding the optimal timing and technique of wound closure. Extensive soft-tissue damage may necessitate the use of local or free muscle flaps. Techniques of fracture stabilization depend on the anatomic location of the fracture and characteristics of the injury.