1. Introduction

Open fractures are common with an incidence of 30 open fractures for every 100,000 people every year, with an average age of 45 years [1]. Depending on the gender, we can distinguish two peaks: in males between 15 and 19 years and in females in patients older than 90 years [1]. Road traffic accidents are the main mechanisms of injury in these fractures, but we have seen an epidemiologic change in the last years because the incidence of open fractures related to motor vehicle accidents have decreased in the twenty-first century [2]. This lower incidence is

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

due to a high decrease in the number of open fractures in the occupants of motor vehicles probably because of the improvement of vehicles and traffic road security. This situation is in contrast with an increase, in the last years, in the incidence of open fractures in cyclist, motorcyclists and pedestrian accidents [2]. There is also a trend to see an increased incidence of open fractures in the elderly due to all mechanisms (high- and low-energy trauma) [1, 3, 4].

The presence of an open fracture is challenging because of several reasons. First of all, it is a complicated situation because of the generation of a bone defect or the presence of complex fracture patterns; second, we have to solve soft tissue coverage, and in some cases, we also have to recover the blood flow to the extremity.

The management of open fracture has evolved during the last few years, with the introduction of algorithms and the integration of the "orthoplastic" management, in several trauma units in hospitals all over the world [5, 6]. We can see in countries, like United Kingdom, the presence of national protocols to favor an early transfer of patients with these injuries to a trauma center, in order to improve the final outcomes (British Orthopedic Association Standards for Trauma 4 [BOAST 4]: The management of severe lower limb fractures).

Table 1. Summary of the Gustilo and Anderson classification, with the division of grade III fractures (red) in grade IIIA,

Management of Open Fracture

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http://dx.doi.org/10.5772/intechopen.74280

Figure 1. Image A: Clinical picture of an open IIIC fracture of the humerus. Image B: Photograph in the operative theater of the early and initial management, by temporary fixation with an external fixator, to facilitate vascular reconstruction

IIIB and IIIC.

and protection of the repair.

In the case of multiple traumatized patients, open fractures should be individually addressed in order to minimize the general complications of a prolonged reconstructive procedure, minimizing the second-hit phenomenon in unstable patients [7–9]. The decision of limb salvage can be difficult to achieve, but in these situations, if we follow a validated protocol, we can optimize the chances of a favorable outcome.

In this chapter, we present the most recent evidence associated with the management of open fractures, with the objective of optimizing the management in these injuries, applying validated protocols in order to maximize the final outcomes obtained in patients with an open fracture.
