A fracture can be defined as the breakage occurring in the continuity of bone or a cartilage that may result due to an accident, bone diseases like osteoporosis or abnormal bone formation. The fracture causes a traumatic pain in the patient and the patient may also go into a state of shock. In cases of fracture, the breakage may be of two types, complete broken bone or incomplete breakage in which the bone may get cracked.
The fracture is broadly categorized into two categories which are closed fracture and open fracture. In case of closed fracture, the fracture occurs within the body whereas in case of open fracture the broken bone and its fragments protrude out of the skin creating an open wound with an increased risk of infection of the bones. The open fracture is also known as compound fracture.
What is a Compound Fracture?
A compound fracture can be defined as the fracture in the bone that protrudes through the skin resulting in an external wound. This may result in shocking pain along with swelling and bruising in the affected region. In the worst cases, it may result in deformation which can further lead to impairment in the movement of the affected area. Complications can also occur and worsen the condition when there is presence of an infection or the wound healing process is quite slow.
Classification of Compound Fracture
The compound fractures are classified into three categories based on the severity of the fractures. These are:
- Grade I type: In case of Grade I type of compound fracture, the wound size is around 1 cm or smaller. The typical features for this kind of fracture are:
- Wound is clean
- Wound is free from foreign particles
- The skin of the wounded area shows no sign of crushing
- The fracture pattern appears to be simple
- Minimal level of contamination in the wound.
- Grade II type: For Grade II types, the wound size is larger than 1 cm with moderate injury to the soft-tissue. The wound does not constitute any degloving injury, skin flapping or contusion. There exists a moderate level of contamination within the wound and the fracture pattern is more complex compared to the grade I type.
- Grade III type: The severity level of the wound in case of grade III type fractures can range from moderate to massive. The wound is generally caused by high velocity injuries that lead to severe crushing of the skin as well as the underlying tissues. The level of wound contamination is also high in such types of fractures. Depending on the severity, the grade III type fractures has three more sub-types which are:
- Grade IIIA: In this type of fracture, there exists sufficient coverage of the underlying soft tissue. The amount of soft tissue damage and level of contamination is around only 7%.
- Grade IIIB: In this type of fracture, the outer membrane of the bones as well as the soft tissue coverage gets damaged severely which renders soft tissue reconstruction as a necessity. The amount of soft tissue damage and bone exposure as well as the level of contamination is between 10 to 50%.
- Grade IIIC: This fracture results in severe vascular injury which needs a repair else it may lead to permanent deformity and impaired functioning of the affected region. The amount of soft tissue damage, bone exposure and the level of contamination are between 25 to 50%.
Treatment of Compound Fracture
The treatment of compound fracture or open fracture is a complicated process. The treatment generally focuses on sealing the fracture with prevention of development and spreading of infection. For the initial treatment, certain investigations are carried out to assess the location and the severity of the injury; this is generally done by using the X-Ray technique. Following the preliminary investigation, the generic treatment is given to the patient immediately. The treatment for compound fracture or open fracture involves below steps:-
- Surgical Cleaning of the Bone: The first step of treatment for compound fracture involves a surgery called irrigation. In this surgery, the bone as well as the site of injury is initially washed which is called irrigation. The surgical cleaning of the bone is done under the effect of anesthesia. This helps in further assessment of injury.
- Removal of tissues that are non-viable and contaminants: Following to the surgical cleaning, another procedure is followed which is called debridement. This procedure involves the removal of foreign particles from the wound. Also, in case there exists’ any non-viable tissue, it is removed in order to prevent the development of infection. The non-viable tissue can be identified by the absence of the blood supply.
- Bone Stabilization: Stabilization of bone is done in order to prevent further damage and development of gas gangrenes. It is done by providing a fixation to the broken bones. The fixation method can be internal or external and might require surgery. The internal fixation involves the proper alignment of bones by holding them with the help of plates, rods and screws which are fixed on the outer surface of the bone. The external fixation technique is done by using a device called fixator. The external fixator ensures that the wound heals without exposure to the foreign particles. The external fixators are of three types depending on the kind of injury:-
- Uniplanar: Used in cases where edges of the broken bones are stable and steady but there exists’ a severe wound.
- Bi-Planar: Used in case of unstable bones along with a significant wound.
- Ring Fixator: It is used when bone loss occurs or there exists extreme instability within the bone. To add on, the wound healing also requires lengthening of the bone.
This fixation can be continued even after the wound heals or post the permanent fixation surgery depending on the stability of the bones.
- Medication: Compound fracture or open fracture treatment requires antibiotics to accelerate the healing process as well as for preventing the infection. These are given to the patient immediately after the fracture.
Recovery for Compound Fracture
The healing of compound fracture or open fracture require a lot of time due to injury of the bone as well as that of surrounding soft tissues.
The rate of healing is dependent on the type of compound fracture or open fracture and the severity of the injury. Since, there is always a possibility of bone infection and non-union of the bone, the compound fracture or open fracture can take as long as eighteen months to heal.
The patient usually feels discomfort, stiffness and weakness post the healing of the injury. Apart from the healing of the bone, body also requires the normal restoration and functioning of muscles along with the required strength and flexibility. The healing process demands cooperation and patience. When healed properly the patient can return to the daily routine and activities; however, care must be taken to avoid any unnecessary overload of the area as it can lead to another fracture due to weakened bones.
Precautions for Compound Fracture
There are certain precautionary measures which should be kept in mind when dealing with a situation in which the patient has encountered an compound fracture or open fracture. These types of fractures demand immediate attention to ensure that no complications come up. Some measures that can be followed are:-
- Quickly attending to the open Fracture Condition: The below points should be kept in mind while attending such an emergency situation:
- Calling the ambulance immediately
- Collecting quick information about the accident to update the emergency personnel.
- Refraining from removal of the foreign objects that are penetrated into the body as it may cause severe bleeding that may result in death.
- Checking for any possibility of other life threatening injuries that needs to be addressed in emergency.
- Offering the First Aid Treatment: The emergency services may take some time in reaching the spot. In the meantime, the wound can be dressed with sterile bandage in order to control the bleeding and reduce the risk of infection. Simultaneously, the patient should be assessed for the symptoms of shock and trauma which may prove to be life threatening. These symptoms may include fainting, weak pulse, anxiety, rapid breathing, blue lips or shortness in catching the breath. In such situation, the vital signs of the patient should be monitored like the pulse and breathing rate and simultaneously, the patient should be made as comfortable as possible.
Compound fracture could be complicated and must not be taken lightly. The first aid must be provided as early as possible and immediate help must be called for. The treatment and the healing time depend on the grade of injury and the damage caused.