Open Fractures Workup

Updated: May 06, 2020
  • Author: Erin Pichiotino, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Workup

Laboratory Studies

Laboratory tests are typically not directly important for the acute care of an open fracture. However, many patients with open fractures will have other injuries that require appropriate laboratory investigation, and Advanced Trauma Life Support (ATLS) guidelines should be followed for workup of the traumatized patient. [10]

Acute bacterial culture of open fracture wounds, before or shortly after initial debridement, is of little clinical utility. [11]  Organisms isolated in the acute phase of treatment do not correlate well with clinical infections that result from open fractures. Therefore, the routine use of cultures at this stage of care is of little benefit to the patient and is not cost-effective.

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Imaging Studies

Basic orthogonal radiographs (typically, anteroposterior and lateral projections) are taken of the injured extremity. The images should include the joint proximal and distal to the area of injury. Oblique images can be used to obtain further information, as needed. Evaluation of skeletally immature patients is often facilitated by use of comparison views of the contralateral extremity or joint involved. (See the images below.)

An open midfoot fracture with bone loss at the bas An open midfoot fracture with bone loss at the base of the first metatarsal, including approximately 66% of the joint surface.
The foot was cared for with serial debridement and The foot was cared for with serial debridement and temporary pinning of the midfoot to preserve alignment with minimal additional surgical trauma.
An antibiotic-impregnated cement spacer was placed An antibiotic-impregnated cement spacer was placed in the bone void, and 12 weeks later, after the pins had already been removed, a midfoot fusion was performed.
Intraoperative image of the midfoot fusion. The ce Intraoperative image of the midfoot fusion. The cement spacer has been replaced by autologous bone graft from the iliac crest.

Computed tomography (CT) and magnetic resonance imaging (MRI) provide further detail of bone and soft-tissue injury, but they often are not immediately needed for the acute management of an open fracture. They tend to be most useful in the management of complex periarticular injuries.

The use of ultrasonography (US) to assess tissue perfusion, myofascial compartment pressure monitoring, and perhaps magnetic resonance angiography (MRA) or enhanced CT imaging of the soft-tissue elements of the extremity are all current areas of intense research and should provide increased levels of predictive data when validated.

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