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Straight, No Chaser: Open Fractures

By Jeffrey Sterling, MD July 21, 2019

I don’t think you need especially gory illustrations for this. I think you get the picture.

open fxs

In a previous Straight, No Chaser, we discussed broken fingers. If you get a “fight bite” (i.e. punch someone and cut your finger on their tooth), or punch through a glass, strike a brick wall or engage in any other number of ill-advised activities, you can receive what’s called an open fracture. An open fracture is a broken bone in which the break of the bone is accompanied by a break in the skin. It certainly isn’t restricted to the hand, as anyone who has fallen from a tree or off a roof can attest. We’re simply focusing on the hand because of its importance to our activities of daily living.

 open fxs1

Open fractures present an ever higher level of risk and danger to you. Theoretically, the injury has communicated from the skin all the way down to the bone, which presents opportunities for damage to additional structures besides the bone and skin, such as tendons, ligaments, muscles, nerves and blood vessels. Never, ever assume that a “fight bite” or any other type of open wound is or will be ok without medical attention. The risk for delayed healing, deformity and other complications is very high with this type of injury.
One particular area of focus regarding open wounds is the propensity for infection. Have you ever heard that a human’s mouth is dirtier than a goat’s? For purposes of causing infections, you should be so lucky as to have buffalo’s breath. An open wound provides free passage into the deep structures in your body. With the hand in particular, including so many structures in close approximation, this is especially dangerous. (Side note: please stop lying to your physician about the nature of your injuries; we’re not the police. We can only help you as much as you provide us with accurate information.)
Open fractures aren’t just regular wounds. They really only result from vicious injuries. This means there is approximately a 40-70% rate of additional injury somewhere else in the body. This can include additional injuries at the site, away from the site and/or contamination of the open wound. Foreign objects may have been placed somewhere within the wound.
Remember: you need to come clean – figuratively and literally. These injuries can lead to amputations of your limbs due to contamination of the bone with subsequent infection.
Treatment of open fractures is discussed in a separate Straight, No Chaser, but you should know the goals of treatment are to prevent infection, heal the bones, and maintain/restore function of the body part involved. Healing and a return to normalcy is up to you as much as it is dependent on the skilled hands of the orthopedic surgeon who will oversee your care. You will need to exercise, and you will need to exercise through the pain. This will provide you with the best opportunity to obtain normal flexibility, motion and strength. You may have a self guided exercise plan, or it may occur via physical therapy.
Ultimately, your recovery will be based on the type and severity of injury sustained. Many patients give up in the face of ongoing weakness, stiffness and ongoing pain. This doesn’t have to be the case. If this even occurs to you, careful following of instructions will lead to how you lead the rest of your life.
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