Controversies in the Management of Open Fractures

O’Brien C.L, Menon M, Jomha N.M*
Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada

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© O’Brien et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Canada; Tel: 1 780 407 2816; Fax: 1 780 407 2819; E-mail:


Open fractures are a common problem encountered by orthopaedic surgeons and comprise a broad spectrum of trauma. Management is guided by principle-based steps aimed at reducing the risk of gas gangrene or suppurative infections, whilst maintaining viability in a favourable soft tissue environment to reduce the risk of delayed or non-union of bone. Aspects of these principles, however, create discussion around several areas of controversy. The specific antimicrobial regimen and its duration are questions that have been evaluated for decades. Like the ever-evolving nature of the bacterial pathogens, the answer to this is dynamic and changing. The “six-hour rule” is a hotly debated topic with fervent perseverance of this dogma despite a gross lack of support from the literature. The most appropriate soft tissue management approach for open fractures – immediate definitive soft tissue closure versus leaving wounds open for delayed closure or definitive management – is also an area of debate. Exploration of these controversies and consideration for the historical context of the supporting literature furthers our understanding of the critical elements.

Keywords: Antibacterial agents, antibiotics, compound fracture, debridement, open fracture, surgery..