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