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Fracture, Open, Emergency Medicine

Christy Rosa Mohler Reviewed 06/2017
 


Basics

Description

  • Continuity between skin violation and fracture site, ranging from a puncture wound to grossly exposed bone

  • Surgical urgency, as delays in care increase risk of infection and rate of c...

Diagnosis

Signs and Symptoms

  • Deformity with nearby violation in skin integrity

  • Neurovascular compromise may occur.

  • Additional traumatic injuries are frequently present.

History

Significant trauma 

Physical Exam

Treatment

Pre-Hospital

  • Moist, sterile dressings over open wounds

  • Immobilize joints above and below fracture.

  • Control bleeding with local compression.

  • Consider tourniquet for traumatic amputations or uncon...

Follow-Up

Disposition

Admission Criteria

Most patients will be admitted for irrigation, débridement, IV antibiotics, and possibly operative fixation. 

Discharge Criteria

Simple open fractures may be washe...

Pearls and Pitfalls

  • Open fractures are surgical urgencies requiring prompt orthopedic consultation.

  • 40–70% of patients with open fractures have other traumatic injuries.

  • Prompt and thorough ED assessmen...

Additional Reading

  • Bucholz  RW, Heckman  JD, Court-Brown  CM, Tornetta  P. Rockwood and Green's Fractures in Adults, 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.

  • Hauser CJ, Adam...

Codes

ICD9

  • 818.1 Ill-defined open fractures of upper limb

  • 827.1 Other, multiple and ill-defined fractures of lower limb, open

  • 829.1 Fracture of unspecified bone, open

  • 828.1 Open multiple fractures involvi...

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