[Management of wounds in fractures with soft tissue injuries]

The results of fracture treatment are based mainly on the correct management of the soft tissues and the correct estimation of damage to muscles and skin. Depending on the extent of the soft tissue damage closed and open fractures are divided into four categories. The important principles in the management of fractures in connection with soft tissue injuries are: Reduction and splinting of fractures and sterile wound dressing at the scene of the accident avoids infection and posttraumatic damage of the soft tissues. Debridement must include the excision of all avascular and polluted skin, muscle and bone. Primary rigid internal or external fixation is considered as optimal for guaranteeing undisturbed healing of fracture and of soft tissues. Wound closure has to be absolutely strainless. In most cases the wound should remain open and be covered with artificial skin. Delayed closure may be done by means of split-thickness skin grafts, muscle transfer or free tissue transfer with microvascular anastomosis. In the future, the surgeon should pay close attention to closed fractures in connection with severe soft tissue damage. Likewise, these injuries demand an urgent and meticulous surgical procedure.