6. Complications

Complication rates in open fractures are dependent on the type of injury. Commonly, we can say that complication rates increase with the Gustilo classification [13, 69]. We can expect a high complication rate for most grade III open fractures, but only a small increase in complications for grade I and II open fractures [69].

For grade I fractures, we can assume a complication rate near close fractures, if they are managed in a proper way, and patients will recover fast [70].

In grade II fractures, the complication rate would be slightly higher than seen in close fractures or grade I [13]. We will appreciate a low increase in the infection rate, and patients would experience a delay in the time until full recovery [70, 71]. In these situations, the use of a plate, if indicated, would not increase the infection rate [71].

In the case of tibial open fractures, from grades IA to IIIA, if they can be managed initially by a nail, with a proper protocol, the complication rate would be similar to close fractures in the first 30 days after the injury [72].

In limb-threatening injuries, if we choose a salvage procedure, we can expect a high complication rate. If we look for the lower extremity assessment project (LEAP) study group outcomes, we will find wound infections in 23% of patients, 31% of non-unions, 5% of malunions and 9% of osteomyelitis [73] in these injuries. These complications would decrease functions in these patients.

Complications would also favor the development of secondary complications, for example, if a patient suffers an infection, he/she will also increase the non-union and delay healing rate (with an odds ratio higher than 4) [74].
