ABSTRACT
The most important factor dictating care of an extremity injury is the presence of an open or closed fracture or joint. An open injury is a skin laceration in communication with either the bone or joint space (Figure 39.1A). A closed fracture has no associated disruption in skin integrity (Figure 39.1B). Complete examination of the injured extremity is mandatory as small lacerations may be subtle but significant. Antibiotics active against Staphylococcus and Clostridia species and tetanus toxoid should be administered immediately upon identification of an open fracture. Open fractures or joint spaces require an exam under anesthesia, debridement of nonviable soft tissue, and copious irrigation. After induction of anesthesia, the extremity should first be washed with soap and water to remove gross contamination and then prepped and draped in a sterile fashion.
