ABSTRACT
Open fracture is a fracture that is in communication with an epithelial-lined surface, commonly the skin or the gastrointestinal tract. An open fracture is usually a high-impact trauma. The patient should first be assessed according to ATLS principles, ensuring that airway, breathing and circulation are adequate. After confirming this, assess the leg. The leg should be immobilised in a plaster of Paris or gutter splint, for comfort and to prevent further displacement at the fracture site. If there is gross displacement or neurovascular compromise the fracture can be manipulated immediately. An open fracture should be debrided within 6–8 hours to remove all non-viable tissue and reduce the bacterial load. The emergency theatre and anaesthetist should be informed. The wound should be re-examined at 48 hours in order to identify and debride any devascularised or non-viable tissue. The wound can be closed using delayed primary suture, healing by second intention, or by using grafting or a flap to cover the wound.
