Open fractures of the extremities. The case for open treatment.

Meticulous care of open wounds in open fractures is essential to prevent development of infection. Wounds should be treated by early excision and early delayed or secondary closure. Primary closure is not necessarily beneficial and can actually increase the risk of infection. Culture for aerobic and anerobic organisms should be obtained at initial examination, and antibiotic treatment should be started before wound excision. The experience at Duke University Medical Center, Durham, North Carolina, during the past 40 years has demonstrated that open treatment of open wounds is safe and highly successful in preventing gas gangrene and osteomyelitis.