Open fractures and infection

Open fractures still represent a major challenge for the treating surgeon and frequently demand a complex of soft tissue and bone procedures to achieve an undisturbed healing with adequate limb function. However, despite improvement in operative techniques and antibiotic therapy septic complications still occur in severe open fracture forms up to 50%. They are still deleterious for the patient as well as a major economic factor for the treating hospital. Radical (repetitive) debridement of the wound and coverage of soft tissue defects are of utmost importance in the prophylaxis of septic complications along with antibiotic therapy. If the local wound requires flap coverage, early performed procedures yield a clear decrease of infection rates even in most severe fracture forms. Osseous stabilization contributes to infection prophylaxis, especially when the implants can be inserted in a minimal invasive way and provide an adequate handling of soft tissues and the wound. Thus, most often intramedullary nails and external fixators are used today for osteosynthesis. Recently developed plates with angular stability offer a promising alternative even in open fractures, especially when there is an extension of the fracture into the meaphyseal area though indications have to be evaluated. Manifest septic complications demand an early and aggressive approach with radical eradication of the septic topic. While acute infections require most often only minor surgical procedures and offer the chance to leave implants in situ, chronic infections usually demand complex reconstructive measures of bones and soft tissues.