Primary Open Reduction and Internal Fixation of Open Fractures

Abstract

Primary open reduction with rigid internal fixation of 50 open fractures is presented. Patients (27) had associated major multiple trauma. Twenty fractures were articular and 26 involved 3rd degree wounds. Infection rate was 4%. A system of staged sequential debridement and wound management is presented. This system apparently contributed to the low infection rate. No secondary amputations occurred. Of the patients, 82% had good functional results using Charnley''s criteria. Fatal post-traumatic cardiopulmonary failure did not occur. Early definitive fracture care employing rigid fixation which avoids casts, and allows improved wound management and early mobilization of the multiple-trauma patient, apparently decreased the cardiopulmonary and metabolic consequences commonly associated with polytrauma patient care.