What is the management of an open radial fracture with lateral angulation?

From the Guidelines

The management of an open radial fracture with lateral angulation requires immediate medical attention following a systematic approach, prioritizing wound irrigation with sterile saline solution, debridement of devitalized tissue, and administration of intravenous antibiotics, as recommended by the most recent guidelines 1.

Initial Management

Initial management includes:

• Wound irrigation with sterile saline solution, as recommended by the AAOS clinical practice guideline summary 1
• Debridement of devitalized tissue
• Administration of intravenous antibiotics, typically a first-generation cephalosporin such as cefazolin 1-2g IV every 8 hours, plus gentamicin 5mg/kg IV daily for more severe contamination
• Tetanus prophylaxis should be administered if the patient's immunization status is outdated

Fracture Reduction and Stabilization

The fracture requires reduction to correct the lateral angulation, which is typically performed under conscious sedation or general anesthesia. Following reduction, temporary external fixation is often necessary to stabilize the fracture while allowing wound management. Definitive fixation, usually with plates and screws, is performed after the soft tissue condition improves, typically within 5-7 days.

Monitoring and Rehabilitation

Regular wound assessments, dressing changes, and serial radiographs are essential to monitor healing progress. Physical therapy should begin as soon as the fracture stability allows, focusing on maintaining range of motion in adjacent joints and gradually increasing weight-bearing as healing progresses. This comprehensive approach addresses both the bone injury and the soft tissue damage, which is crucial because open fractures carry significant risks of infection, nonunion, and functional impairment if not managed appropriately, as highlighted in the study on pathogenesis and management of fracture-related infection 1.

Key considerations in the management of open radial fractures with lateral angulation also include the use of perioperative and postoperative systemic antibiotics, as well as the potential benefits of local antibiotic strategies as an adjunct to systemic therapy, as discussed in the AAOS clinical practice guideline summary 1 and the study on antibiotic prophylaxis 1.

From the Research

Management of Open Radial Fracture with Lateral Angulation

• The management of an open radial fracture with lateral angulation involves a combination of surgical and non-surgical interventions, with the primary goal of achieving proper alignment, stabilizing the fracture, and preventing infection 2.
• In cases of open fractures, antibiotic prophylaxis is crucial to prevent infection, with cephalosporins being the recommended choice due to their broad spectrum of activity 3, 4.
• For open radial fractures with lateral angulation, the treatment approach may involve:
  • Closed reduction and cast immobilization, which can be effective for fractures with minimal displacement and angulation 5.
  • Surgical intervention, such as open reduction and internal fixation, may be necessary for more complex fractures with significant displacement or angulation 2.
• The use of antibiotic prophylaxis in open fracture management is supported by the literature, with the extent of the injury determining the appropriate agent and duration of treatment 6, 3, 4.
• It is essential to consider the grade of the open fracture when selecting an antibiotic regimen, with first-generation cephalosporins recommended for Grade I and II open fractures, and additional coverage with an aminoglycoside for Grade III open fractures 3.