Open Fractures & Soft-Tissue Injury
Recognise open injuries and coordinate early protective care and specialist management.
Quick revision ↓ Medical Dictionary
01Recognise communication
Any wound near a fracture raises concern for an open injury, even when the skin opening is small or away from the most obvious deformity. Do not judge severity solely by wound size. Assess contamination, energy, perfusion and soft-tissue damage alongside the whole patient.
02Early priorities
Follow the trauma assessment, provide analgesia and document neurovascular findings. Give prompt intravenous antibiotics according to the open-fracture pathway and assess tetanus protection. Align and splint through an appropriately trained team when indicated, with reassessment; preserve information needed by the receiving service.
03Protect the wound
Avoid repeated probing and unplanned bedside washouts of major open fractures. Remove only gross contamination as directed, cover using the appropriate sterile dressing and minimise repeated exposure. Document or photograph according to consent and policy so specialist teams can assess without unnecessary handling.
04Specialist surgery
Debridement, stabilisation and definitive soft-tissue cover require coordinated orthopaedic and plastic-surgical planning for relevant injuries. Timing depends on contamination, vascular compromise and injury severity under current standards. Highly contaminated or ischaemic injuries need particularly urgent care; a universal delayed timetable is unsafe.
05Aftercare and complications
Monitor wound condition, infection signs, circulation and healing. Explain the possible need for staged procedures and the uncertainty of recovery. Rehabilitation, psychological support and prevention of further injury are part of care. A small skin wound does not mean the subsequent treatment or follow-up will be minor.
High-Yield Revision
- A small wound can accompany a severe open fracture.
- Antibiotics and tetanus assessment are early priorities.
- Coordinate fixation and soft-tissue cover.
Common Pitfalls
- Probing a wound repeatedly to demonstrate communication.
- Delaying referral because the wound looks small.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.