Osteomyelitis in open fractures

Any fracture which connects to a wound in the skin must be managed as an open fracture. The haematoma around the fracture acts as a perfect culture medium if any organisms succeed in colonising it. The key to avoiding this situation is to open the wound, fully wash out the haematoma and remove any dead or contaminated tissue. The fracture should then be stabilised and the wound left open. The wound should then be checked every 24—48 hours until it is clear that all dead and contaminated tissue has been removed and clean granulation tissue is forming. Then, and only then, can delayed primary closure (DPC) be attempted.

Osteomyelitis in open fractures

All open fractures are contaminated

Wash out and remove dead tissue

Leave wound open

Only close once wound is clean