ABSTRACT
This chapter explains the fundamental principles of open fracture management and highlights the major areas of controversy, along with the BOAST-4 guidelines. Open fractures frequently result from high-energy trauma, often with extensive soft tissue injury and contamination. If the open fracture involves the tibia or if there is significant soft tissue injury, a plastic surgeon should also be present. The Tscherne classification was developed with two categories, one for open fractures and one for closed fractures. Today, surgical debridement of open fractures consists of removing all dead and devitalized tissue, along with any contamination. However, this approach evolved in the context of war wound management, and many subsequent authors have advocated immediate closure on the following premises: However, it must be stressed that immediate primary closure should be undertaken only after thorough debridement and in cases where skin edges are opposable without excessive tension.
