[Prognosis and complications of open fractures]

This paper reviews records of Liestal Country hospital, AO Catalogue files and National Swiss Insurance Industry actuarials regarding open fractures. Specific regards are tended toward prognosis forecasting, complications and outcome assessments with respect to industrial "down time" resulting from bone infections and/or pseudarthroses. Evaluation of injuries is contingent upon the Gustilo Classification (1987) which bases prognosis on soft tissue preservation in open fracture injuries. We adhere to well accepted protocols which provide for adequate local primary débridement and stabilization of structural osseous components by means of appropriate fracture fixation. In addition, we have implemented protocols for the preservation of bony vascular elements along with sequential provisions for cancellous bone and soft tissue grafting. Outcome assessments on the range of cases reviewed confirm a traditional perspective that open fractures demonstrate considerably greater morbidity than closed fractures. However, by comparison with previous studies, the results of this series show positive progress toward optimal wound healing. While this more aggressive approach tends initially to be quite expensive, we believe initial costs to the carrier are justified by improved outcome, prognosis and industrial down time.