A compound fracture is a serious condition and treatment must start forthwith. The nature of the lesion may vary from a small puncture to a large contaminated wound with bone fragments protruding outside. Treatment is based on the following principles.
Control of Bleeding
Pressure bandage: A firm pressure bandage is applied around the wound and immobilization is done by splinting.
Tourniquet: Tourniquet can be applied in difficult cases where bleeding is uncontrollable. Prolonged interruption of blood supply will lead to the development of gangrene.
Elevation of the limb: The affected limb is kept elevated.
Antibiotic: The commonest bacterial invaders are penicillin-sensitive Staphylococcus aureus. The Cl. welchii is also sensitive to the same antibiotic. Early administration of penicillin by intramuscular route is ideal in most cases.
Injection of Antitoxin: Injection of A.T.S. may produce an anaphylactic reaction and gives only incomplete protection. This technique is, therefore, going out of favor. A.T.S. is recommended only in contaminated and large wounds along with administration of toxoid. Most of the cases with non- contaminated and small wounds are actively immunized by toxoid administration along with the antibiotic cover.
Anti- gas gangrene Serum: Anti- gas gangrene serum (9000 units) may be given where muscle tissues are widely damaged and contamination with soil and road dust is present.
Cleaning the Wound: This is one of the most important parts of treatment. Cleaning must be meticulous and a good deal of patience is required. General anesthesia is necessary in most cases to perform proper cleaning without giving pain to the patient.
Preparation of the limb: The skin is prepared by shaving and cleansing the area with surgical spirit, iodine or Cetavlon solution.
The method used for cleaning the wound: Plenty of sterile saline solution is essential. Different antiseptic solutions like hydrogen peroxide, Cetavlon, Hibitane are commonly used. The very strong antiseptic solution should be avoided. All aseptic precautions are taken. Cleaning is done by using large pieces of gauze soaked in the sterile solution. With the aid of a syringe the solution can be forcefully sprayed into the cavity of the wound. This will help to eject foreign bodies and contaminated materials.
Excision of Wound Margins and Tissues: The ragged wound margins are excised. The dead muscles are removed. Their presence is dangerous because bacteria can proliferate on dead tissues.
Bone Fragments: Detached bone fragments that are exposed on the wound surface should be removed. They do not help in the process of bone union.
Care of Fracture
Reduction of fracture: This is performed under general anesthesia. In cases where the bone is completely exposed, the reduction can be achieved under vision.
Closure: The ideal procedure is the primary closure of the wound. Attention is directed during the approximation of the wound margins so that the suture lines are not put to any tension.
Secondary closure: This is done especially when the wound is situated over the soft tissue and not over the bone. The exposed surface is covered by sofra-tulle or Vaseline gauze. The secondary closure is done at a later date when the infection is controlled, and the wound becomes healthy.
Other procedures in skin closure: When difficulty arises in the primary closure of the wound, several other techniques may be adopted.
Undermining the wound: With the aid of a pair of scissors, cleavage is made in the subcutaneous plane at the margins of the wound. This may enable approximation of the wound margins during the process of suturing.
Relaxing incision: Relaxing incisions are made on both sides of the wound which sometimes help to bring the original wound margins together.
Skin graft: Skin taken from a different place may be applied to cover the raw area.
Flap procedures: Different plastic procedures: Different procedures like rotational flap, direct and tube pedicle flap techniques may be performed to cover the bare area of wound.
After-care: This comprises of control of shock, combating infection by suitable antibiotics, and immobilization of the fractured part. If the wound has been left without closure, it should be examined after 6-7 days. Skin graft may be required for closure after the said period.
A technique of Fracture Reduction
Reduction and plaster immobilization: The ideal treatment is to reduce the fracture, followed by plaster immobilization. This is possible in simple cases where primary skin closure is done.
Plaster immobilization and window formation: A window opening in the plaster can be made where chances of infection exist. This will enable future inspection and treatment of the wound.
Skeletal traction: In some case of unstable fractures, plaster immobilization may not succeed. Skeletal tractions are necessary for these types of cases.
Internal fixation: In the case of compound fracture, operative fixation is usually avoided. There is always a chance of introducing infection inside the bone leading to serious complications. Internal fixation is the answer where associated vascular injury co-exists, fracture is unstable and not amenable to other conservative measures. Implants used in Internal fixation is supplied by orthopedic implants companies worldwide. Orthopedic surgeon or distributor can easily find the orthopedic implants importer in Indonesia. We are the top rated manufacturer in India and provide worldwide delivery of implants and instrument sets.