From the Guidelines
The treatment of an open fracture of the toe should prioritize prompt administration of antibiotics, such as cefazolin or clindamycin, to prevent infection, as recommended by the American Academy of Orthopaedic Surgeons 1. The initial management of an open fracture of the toe includes gentle cleansing of the wound with sterile saline solution, application of a sterile dressing, and elevation of the foot to reduce swelling. Medical professionals will likely administer tetanus prophylaxis if the patient's immunization is not current. Pain management typically involves acetaminophen 650mg every 6 hours and/or ibuprofen 400-600mg every 6 hours as needed. The fracture itself may require surgical debridement to remove contaminated tissue, followed by reduction (realignment of bone fragments) and stabilization using pins, wires, or external fixation in severe cases. For less severe fractures, buddy-taping the injured toe to an adjacent healthy toe with gauze padding between them provides stability. Weight-bearing restrictions and protective footwear like a post-operative shoe or walking boot will be necessary for 4-6 weeks. Follow-up with an orthopedic specialist within 1-2 weeks is essential to monitor healing and adjust treatment as needed, with consideration of local antibiotic prophylactic strategies, such as vancomycin powder, tobramycin-impregnated beads, or gentamicin-covered nails, which may be beneficial 1. Early delivery of antibiotics is crucial to lower the risk of deep infection in the setting of open fracture in major extremity trauma, as suggested by the American Academy of Orthopaedic Surgeons 2. Key considerations in the treatment of open fractures of the toe include:
- Prompt antibiotic administration to prevent infection
- Gentle wound cleansing and dressing
- Tetanus prophylaxis as needed
- Pain management with acetaminophen and/or ibuprofen
- Surgical debridement and stabilization for severe fractures
- Buddy-taping for less severe fractures
- Weight-bearing restrictions and protective footwear
- Follow-up with an orthopedic specialist to monitor healing and adjust treatment.
From the Research
Treatment for Open Fracture of the Toe
- The treatment for an open fracture of the toe typically involves wide-spectrum antibiotic therapy, which should be initiated as soon after injury as possible, preferably within 3 hours of injury 3.
- Surgical debridement is also a crucial step in the treatment process, and while the timing of debridement is often debated, studies suggest that it can be safely performed up to 24 hours after injury without significant impact on infection rates 4.
- The management of the bone and soft tissues is critical in determining fracture healing and functional restoration of the injured extremity, and a soft-tissue treatment plan should be formulated during the initial wound assessment and fixation of the open fracture 3.
- The selection of fracture fixation depends on various factors, including the fractured bone, location of the fracture, extent of soft-tissue injury and contamination, and the physiologic status of the patient, and may involve the use of intramedullary nailing or other stabilization methods 5.
- In some cases, primary wound closure may be considered a safe option after thorough debridement and fracture stabilization, particularly for less severe open fractures 6.
- The use of antibiotic bead pouches and vacuum-assisted wound closure may also help reduce the risk of secondary and nosocomial contamination and subsequent infection 3.
- Overall, the treatment of open fractures, including those of the toe, requires a comprehensive approach that takes into account the unique characteristics of the injury and the individual patient, and may involve a combination of antibiotic therapy, surgical debridement, fracture stabilization, and soft tissue reconstruction 3, 4, 7.