What is the treatment for an open radial fracture?

From the Guidelines

The treatment for an open radial fracture requires immediate medical attention, typically involving a multi-step approach, with the most critical step being the prompt administration of intravenous antibiotics, such as cefazolin 2g IV for adults, within 3 hours if possible, as recommended by the most recent and highest quality study 1. The patient should receive antibiotics promptly to reduce the risk of infection, and the choice of antibiotic should be based on the severity of the wound and the likely organisms contaminating the wound.

• The wound requires thorough irrigation and debridement in the operating room to remove contamination and devitalized tissue, using simple saline solution without additives, as recommended by the American Academy of Orthopaedic Surgeons 1.
• Temporary stabilization with an external fixator is often performed initially, followed by definitive fixation (internal plates and screws or intramedullary nailing) once the soft tissue condition improves.
• Tetanus prophylaxis should be administered if the patient's immunization status is outdated.
• The fracture will need to be immobilized with a splint or cast after surgical intervention, and regular follow-up appointments are essential to monitor healing and detect complications. The goal of this aggressive approach is to minimize the risk of infection and promote optimal bone healing, as open fractures expose bone to external contaminants, significantly increasing infection risk and potentially compromising bone healing if not properly managed, as highlighted in the study by Patzakis et al 1.
• The use of perioperative and postoperative systemic antibiotics for open fractures is strongly recommended, with cefazolin or clindamycin being the preferred choices, and the addition of an aminoglycoside for Gustilo/Anderson Type III open fractures, as recommended by the American Academy of Orthopaedic Surgeons 1.
• The role of negative pressure wound therapy (NPWT) is not recommended for open fractures, as it does not mitigate the risk of developing a surgical site infection (SSI) in this context, as stated in the study 1. It is essential to note that the optimal timing for surgical intervention is still debated, but it is suggested that patients with open fractures are brought to the operating room for debridement and irrigation as soon as reasonable and ideally before 24 hours post-injury, as recommended by the American Academy of Orthopaedic Surgeons 1.

From the Research

Treatment Overview

The treatment for an open radial fracture typically involves a combination of surgical and non-surgical interventions. The primary goals of treatment are to promote healing, prevent infection, and restore function to the affected limb.

Surgical Interventions

• Open reduction and internal fixation (ORIF) may be used to treat open radial fractures, particularly those with minimal comminution and few articular fragments 2.
• Immediate internal fixation may be employed in certain cases, such as polytraumatized patients or those with type III open fractures, to facilitate soft tissue care 3.
• Debridement and irrigation are essential components of surgical treatment, with the goal of removing infectious material and promoting a clean wound environment 4, 5.

Non-Surgical Interventions

• Antibiotic prophylaxis is crucial in preventing fracture-related infection (FRI) and should be administered as soon as possible 4, 5.
• Negative pressure wound therapy (NPWT) may be used as an adjunctive treatment to promote wound healing and reduce the risk of infection 6.
• Soft tissue coverage, such as skin grafts or flaps, may be necessary to promote wound healing and prevent infection 4, 5.

Timing and Type of Wound Closure

• Early debridement and wound closure are critical in preventing infection and promoting healing 5.
• The type of wound closure, whether primary or secondary, depends on the severity of the fracture and the condition of the soft tissues 3, 5.

Additional Considerations

• The use of local antibiotics, such as antibiotic beads, may be beneficial in preventing infection 5.
• The application of vacuum-assisted closure (VAC) therapy may not be beneficial in reducing infection risk or improving outcomes, but may enhance treatment costs 5.
• Recombinant human bone morphogenetic proteins (rhBMP)-2 may be used to promote bone healing in certain cases, such as Gustilo-Anderson type III open tibial shaft fractures 5.