[Pathophysiology of open fractures and principles of their treatment. Review]

Authors have worked out in detail the problems of fractures associated with the injury of soft tissues. They use their own classification dividing these fractures into two major groups, and namely open and closed fractures. In each group they distinguish 4 degrees of severity of the injury of soft tissues. Of decisive importance for both the final result and the course of the treatment is the method of treatment which starts already on the scene of the injury. The whole therapeutical management up to the actual operation has several successive phases. The way of osteosynthesis can be decided upon only after the primary treatment of the wound which makes it possible to evaluate properly the condition of soft tissues and the contamination of the wound. Of vital importance is the radicalism of the primary treatment and the removal of all necrotic tissues. Potential defects can be temporarily covered with artificial skin and permanently with skin grafts or muscular, myocutaneous or fasciocutaneous flaps.