Proper management of open fractures is essential. Open fractures should be treated as a medical emergency, once more pressing problems are addressed (See Table 18).1,2
Initial management of open fractures during resuscitation. While evaluating the entire patient and initiating life-saving therapy, take measures to protect the open fracture site:
- Do not attempt to reduce bone(s) protruding at fracture sites, as this drags contamination to the fracture site and may cause injury to the neurovascular bundle.
- Quickly remove any large gross contaminants from the wound (e.g., leaves, rocks, stick fragments), but do not attempt to clip the hair or cleanse the wound at this point.
- Cover the fracture and wound with sterile non-adherent dressing and apply a light bandage. This bandage should not be placed in an attempt to stabilize or immobilize the fracture at this time; it is simply to protect the open wounds and exposed bone from further contamination during initial patient resuscitation.
Specific management recommendations for open fractures. MWDs with open fractures generally will require surgical correction of the fracture once evacuated to veterinary facilities. The overriding aims are to prevent bacterial infection and promote normal healing.
- Culture open fracture sites as soon as possible after presentation and before antibiotic use if possible.
- Administer antibiotics as per Table 20 in CPG 14, focusing on use of intravenous antibiotics based on likely contaminants. Never withhold antibiotic therapy in any patient with an open fracture.
- Address pain with appropriate analgesic therapy (See CPG 16). Reassess pain every 4-6 hours.
- Manage soft tissue injuries over the fracture site appropriately, as proper management of the wound postures the patient for successful outcome. See CPG 14 for wound management recommendations.
- After appropriate wound care, apply a sterile moisture-retentive bandage over open fractures, as it is important to keep soft tissues and bone moist for optimal healing. Change bandages at least once daily, based on degree of strike-through, soiling, or loosening.
- Apply splints and bandages as described previously for open fractures of the radius/ulna or tibia, or lower aspects of the limbs. Confine MWDs with any fracture, but especially with upper limb fractures that cannot be immobilized.
Table 18. Management of Long Bone Fractures in MWDs