It’s World Trauma Day. A ‘compound’ or ‘open’ fracture refers to a break in the bone with a laceration in the overlying skin, leaving the fracture fragments open to the outside environment. This is a very serious injury with potential long term consequences if not treated appropriately.
In the unfortunate event of a compound fracture, patients should remember the following tips:
1. A compound fracture is a true emergency, and appropriate care should be sought immediately. Usually, this involves calling the local emergency ambulance service to ensure that the patient is transferred safely to a hospital with an on-call orthopedic surgery team. In most situations, the patient will require an emergency surgical procedure to clean the wound and treat the fracture.
2. While waiting for care to arrive, the patient should not move around unnecessarily, because the fracture is open to the outside environment and could become infected. One of the major consequences of a compound fracture is an infection at the fracture site, which should be avoided at all costs.
3. One should not try to re-align the extremity where the bone is broken without the presence of trained medical personnel who have the proper splinting supplies. Improper handling could cause contamination of the wound and damage to the traumatized tissues.
4. Try to keep the extremity as clean as possible. Place moist sterile gauze over the wound if available. At a minimum, the wound should be protected from contact with the ground or unclean surfaces.
5. Pay attention to signs of compartment syndrome. This is a serious complication of extremity trauma that develops over time; it is caused when swelling increases pressure at the site of the injury. If the pressure from the swelling becomes greater than the incoming blood pressure, the extremity receives no blood. Immediate surgical intervention to release the pressure is required if this situation arises. In addition to swelling, warning signs include increasing pain, numbness, weakness, decreasing pulse, and a color change in the extremity. If not treated properly, compartment syndrome can lead to permanent muscle and nerve damage.