Complications
A patient with an open fracture is at high risk of complications in the lesion. In particular, a prolonged fusion of the fracture (delayed consolidation) or lack of adhesion (non-growth of the fracture), as well as infection of tissues in the open fracture region, is possible. Disturbance of adhesion is caused by soft tissue damage at the site of fracture; their loss leads to a lack of local circulation, which prevents the consolidation of the fracture.
Infection
Sources of infection are the skin of the patient himself, his clothes or various objects on the scene; bacteria easily penetrate into the open wound and fracture area. If there is infection of the bone itself (osteomyelitis), treatment is greatly complicated. Most antibiotics do not penetrate the bone. Once infection of the bone is established, the disease is considered as a chronic osteomyelitis. As a result, the patient faces a number of problems, such as:
• long-term incapacity for work;
• pain;
• edema;
• recurrent exacerbations of the infection;
• the formation of fistulas (ducts leading from the bone to the surface of the skin) that produce pus.
Against the background of progressive infection, a normal process of fracture fusion is impossible. Periodic necrosis of bone sites disrupts adequate fixation and attachment of fragments. The principles of treatment are decontamination of the wound (purification from bacteria), maintenance of the viability of tissues, as well as the application, if necessary, of plastic surgery techniques to stabilize bone fragments. Bone fragments are initially stabilized by an external fixator. A lot of external fixators of different shapes and sizes have been developed, for installation of which the surgeon uses special equipment. A special X-ray machine - an image intensifier - allows you to take pictures displayed on the monitor screen, right during the operation. Thus, the surgeon can make sure that both the bone fragments and the elements of the outer retainer are positioned correctly. To use the image intensifier, the surgeon must complete a special course on safety and radiation protection, and the operating personnel must necessarily wear lead aprons. Restoring the integrity of the skin is achieved with a special tool - dermatome, which is used to obtain skin grafts; the connection of the finest anatomical structures is carried out under a microscope. To confirm the correct location of the elements of the external fixator, the orthopedic surgeon performs a series of X-ray images using a special image intensifier. An open fracture can be the result of a motorcycle accident, in which the limbs are subjected to a powerful traumatic effect.