Synopsis
Identify every fracture communicating with the external environment, prevent additional contamination, deliver antibiotics and alignment promptly, describe rather than prematurely grade the wound, and coordinate definitive debridement, fixation and coverage through orthoplastic care.
- Treat any wound in the same segment as a fracture as communicating until careful operative assessment establishes otherwise; visible bone is not required.
- Control haemorrhage with direct pressure, packing or the most distal effective tourniquet and never apply blind clamps inside the wound.
- Give the network's intravenous prophylactic antibiotic as soon as possible and ideally within one hour; record agent, weight-based dose, allergy check and exact time.
Key red flags
Uncontrolled bleeding, a persistently dysvascular limb after realignment, expanding haematoma, bruit or neurological deterioration requires simultaneous resuscitation and NCEPOD-1 vascular and skeletal care.
Investigation priorities
Define the fracture and joint extension while the limb is protected.
Management branches
A fracture has any potentially communicating wound or major soft-tissue violation.
- Run ABCDE, control bleeding without blind clamping and document the entire limb, compartments, pulses and named nerves.
- Give network intravenous prophylaxis ideally within one hour and assess tetanus needs without waiting for radiographs.
Key medicines
Immediate intravenous open-fracture prophylaxisGive the trauma network's specified intravenous agent at its current adult weight-based dose as soon as possible and ideally within 1 hour of injury; record allergy, agent, dose and time and repeat only at the protocol-defined interval.