Medical Legal Open Fracture

It is estimated that between 3.5 and 6 million fractures occur each year in the United States.1,2 Extrapolating from European data, we can estimate that more than 3%, or 150,000, are open fractures.3,4 After adjusting for population differences, we predict that more than 4.5 million open fractures occur in India each year. This figure may be underestimated, given the high population density in India`s major urban centres. These fractures can be associated with significant morbidity and are inherently worrisome because the body`s protective skin barrier has been breached and the potential for contamination is high. Correct and timely treatment of these injuries can benefit our patients and lead to more favorable results. Open fractures often result from high-energy trauma and communicate with the external environment and therefore present an increased risk of infection.13–14 Cornerstones of management include detection, administration of appropriate antibiotics, stabilization of the fracture, and proper irrigation and debridement of wounds. Open fractures may require several surgeries to achieve adequate soft tissue coverage and fracture healing. Problems associated with open fractures include infections, flap loss, and bone problems. The risk of infection increases with the severity of the injury and can reach 50% in type III cases. The high risk is partly due to direct communication with external pathogens, reduced vascularization of the injury site, tissue alteration during severe trauma, and the need to insert ironwork to stabilize fractures. Therefore, early treatment with antibiotics should be considered almost mandatory for these patients, as it can reduce the risk of infection.

Reduction of grossly deformed fractures can be tried in the emergency department, especially for neurovascular impairment and patient comfort. All patients with neurovascular disorders need urgent reduction and additional vascular treatment. A patient with an ankle-arm index of <0.9 should be evaluated by angiography.5 The wound should be carefully examined and characterized according to the Gustilo-Anderson classification system for open fractures, as this prescribes initial treatment. Gustilo-Anderson type I open fractures are a low-energy injury with wounds less than 1 cm and minimal soft tissue damage. Type II fractures are low- to moderate-energy injuries with wounds larger than 1 cm and moderate muscle and soft tissue damage. Type IIIa lesions result in severe soft tissue damage by crushing, type IIIb tissue damage results in significant loss of tissue coverage, and type IIIc vascular lesions are significant associated with tissue damage. Since patients with open fractures typically experience significant trauma, arterial blood gases (ABG), haemoglobin, haematocrit, platelet count, metabolic panel, serum lactate and toxicological screenings are often warranted. Simple X-rays are usually sufficient to assess the extent of the fracture. At least anteroposterior and lateral views of the injured bone should be obtained. The joints above and below the injury should also be X-rayed, as the fracture could spread into adjacent joints or affect joint surfaces. Air on simple X-rays in the muscle, subcutaneous tissue or joint, and visible foreign bodies indicate an open wound. If the patient is stable, a CT scan of the ankle or knee joint may be helpful in characterizing fracture orientation and assisting with reduction and fixation plans.

In the absence of pulses, CT angiography may be used to identify vascular lesions. [7] [8] If a person suffered a compound fracture in an accident in California, they may be eligible for compensation. This can include past and future medical bills, loss of income, loss of future income, and pain and suffering. However, the claims process is not easy, as various factors can be involved. Watch this video to learn more. Levy et al. (1997) examined 40 open fractures in children with an average age of 10 years and an average follow-up of 26 months (18 to 84 months). They found that the children surveyed missed an average of 4.1 months of school and that 33% had to repeat the year, 25% complained of nightmares and despite a firm union, 30% complained of chronic pain.