[Medical Q&A] What are the emergency treatment measures for sudden open fractures?

Planner: Chinese Medical Association

Reviewer: Shao Zengwu, Chief Physician and Professor of Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology

The goal of treating open fractures is to achieve early healing of soft tissue and fracture and to avoid complications such as infection, nonunion, and joint stiffness.

1. Hemostasis treatment: Open fractures can cause bleeding. If the amount of bleeding is too much, the patient will fall into shock and must be treated as soon as possible. Be sure to elevate the affected limb and apply pressure bandage. If blood continues to seep in, a tourniquet must be used to stop the bleeding.

2. Sedation and analgesia: If the patient cannot tolerate pain, sedation and analgesia must be performed, and opioids (such as morphine and fentanyl) can be injected. If the analgesic effect is not good, sedatives (such as propofol, midazolam, etc.) need to be added. If conditions permit, peripheral nerve block can be performed.

3. Thorough debridement: The wound must be thoroughly cleaned and covered with sterile dressings, and then fixed with plaster or splints. To prevent infection, patients must be injected with tetanus immunoglobulin, or tetanus antitoxin can be used.

4. Fracture fixation: External fixators, intramedullary nails, and plate screw systems are three common fracture fixation systems. Previously, external fixators have been considered the main device for treating open fractures, but with the development of early wound closure technology and the emergence of highly effective antibiotics, intramedullary nails and plate screw systems have been widely used in the treatment of open fractures.

5. Soft tissue reconstruction: In addition to good debridement, another important factor that determines the efficacy of open fracture treatment is to quickly convert open fractures into closed fractures through adequate soft tissue coverage.

Open fractures are mainly caused by high-energy violence. The patient's bones and soft tissues are severely traumatized, often complicated by infection, which can cause disability. Treatment must be carried out as soon as possible. Thorough debridement must be ensured, and postoperative fixation should be done well. Before the wound is completely healed, the patient must rest in bed and reduce activity.