Classification and management of acute wounds and open fractures

Acute traumatic wounds and open fractures potentially cause significant morbidity and loss of function. Much of the management of these types of injuries has been developed from the experience of military surgeons during times of armed conflict. The approach to management should start on initial assessment using trauma resuscitation protocols. Once life-threatening injuries have been managed, the wound should be thoroughly debrided and the skeleton stabilized. In the presence of heavy contamination, the wound must be re-inspected after 48 hours to evaluate whether further debridement is necessary and plans for soft tissue coverage can be made. The approach to management of open fractures should be systematic, involving both orthopaedic surgeons and plastic surgeons from the outset.