Open fractures are a common type of trauma in clinical practice. Patients often suffer from high-energy injuries such as traffic injuries, falls from heights, and crushing injuries, with severe symptoms, high potential risks, and significant psychological conflicts. However, even patients are often unclear about the specific condition of open fractures. So what is an open fracture? How should we handle it?
1、 What is an open fracture? An open fracture refers to the rupture of the skin or mucosa at the site of the fracture, with the fracture end connected to the outside world. Patients often experience pain, local swelling, bleeding, functional impairment, etc. In severe cases, it can lead to disability or multiple organ failure, and even endanger life. Therefore, it is usually recommended to seek medical treatment actively. Patients with open fractures have complex and diverse conditions, but if they can be treated in a timely and standardized manner, they can often achieve better treatment results and a better prognosis.
2、 How to provide on-site first aid for patients with fractures?
The purpose of first aid is to use simple and effective methods to save lives, protect affected limbs, and enable them to be safely and quickly transported to nearby hospitals for proper treatment.
(1) General treatment: First, save life, fight shock, receive blood and intravenous fluids, and maintain airway patency.
(2) Wound dressing: Use a bandage to compress and wrap the wound. When there is large blood vessel bleeding, a tourniquet can be used. If the fracture end is punctured and infected, it should not be immediately reduced.
(3) Proper fixation: First correct the deformity, then fix it, using special clamps or tree branches, wooden sticks, etc. (4) Rapid transportation.
The significance of using temporary fixation for emergency treatment of fractures is threefold: (1) to avoid further damage to soft tissue nerves or internal organs caused by the movement of the fracture end during transportation;
(2) Pain relief can be achieved after fracture fixation, which is beneficial for preventing shock. (3) It is easy to transport.
3、 How to deal with open fractures
The principle of treating open fractures is to timely and correctly handle the wound, avoid infection as much as possible, and strive to transform open fractures into closed fractures.
(1) For closed soft tissue injuries, it is advisable to elevate the injured limb and apply cold compress in the early stage and hot compress in the later stage to facilitate venous return and reduce edema or pain. Soft tissue injuries that are not accompanied by visceral and joint injuries can generally be cured smoothly.
(2) For open wounds, debridement surgery is also necessary. According to the degree of injury, contamination, and time after injury, wounds can be classified for debridement.
The earlier the wound is cleared, the less chance of infection and the better the treatment effect. It is generally believed that debridement should be carried out within six to eight hours after injury, and the majority of wounds can heal in one stage. Therefore, efforts should be made to do so within this period as much as possible. The temperature is low in winter, and the debridement time can be appropriately extended. After the debridement process is completed, choose an appropriate fixation method based on the severity of the injury to fix the affected limb. Simultaneously using antibiotics to prevent infection.
4、 Complications of open fractures
1. Massive blood loss: Open fractures are generally severe high-energy injuries that cause the fracture site to puncture tissue and skin. If there are important blood vessels running around the fracture site, it can lead to severe vascular damage and massive blood loss. At the same time, the fracture site is open, and the bone marrow of the fracture will also experience significant blood loss, which can be life-threatening in severe cases.
2. Nerve injury: If the fracture ends and punctures the tissue, it may cause tearing or damage to the surrounding important nerve tissue, leading to the loss of corresponding nerve function and causing limb dysfunction.
3. Infection: Even after debridement, there is still a chance of infection in open wounds, especially in wounds with severe pollution and a lot of dead tissue, such as abdominal, perineal, and oral and maxillofacial wounds, which are more prone to infection. Therefore, antibiotics should be used preventively based on specific circumstances. In addition, patients with open trauma should receive tetanus antitoxin serum or tetanus immunoglobulin treatment to prevent tetanus. Animal bites should be treated with rabies vaccine at the same time.
4. Disability: Severe open fractures can lead to limb disabilities, with poor prognosis, difficult wound healing, significant loss of function, and often disability of limbs.
5. Abnormal healing and myositis ossificans: Due to the above conditions, the limbs are extremely difficult to heal, resulting in abnormal healing. At the same time, the surrounding healing muscle tissue will be affected by osteoblasts to form myositis ossificans.
Five function exercise guidance
On the basis of reduction and fixation, exercise the injured limb and the whole body to promote fracture healing and restore limb function and overall health.
(1) Promote the serious consequences of death and disability caused by trauma and the importance of prevention, in order to draw widespread attention. Once injured, seek medical attention promptly.
(2) Strengthen functional exercise during the recovery period after injury, promote the recovery of body function, and prevent complications such as muscle atrophy and joint stiffness.
(3) Internal and external medication and other adjuvant treatments
In short, open fractures must be treated as soon as possible, otherwise the situation will be very serious and may cause more complications. Firstly, attention should be paid to the time and key points of debridement. In addition, tissue recovery should also be promoted as soon as possible. Generally, as long as the method is correct, the condition can be effectively controlled and there will be no more risk of malignancy.