ABSTRACT
INTRODUCTION Open fractures, particularly those that have been caused by high-energy impact, or which involve crushing, pose considerable management problems to the surgeon. While stabilization and fixation are essential to restore function to the affected area, these processes also increase the risk of deep infection which may lead to amputation or even death. Immobilization with casts and traction is less invasive and carries a smaller risk of inducing infection, but may increase the risk of compartment syndrome and pulmonary embolism. While there is an overall accepted management protocol-prophylactic administration of antibiotics, meticulous debridement, copious irrigation, stabilization of the injury, early soft tissue coverage-each patient presents with a unique set of problems. The surgeon constantly has to balance one approach against another, trading off a possibly increased risk of infection for better stabilization, or earlier functionality, or balancing the need for early closure against the need for recovery of soft-tissue injuries.
