How to manage them initially
A fracture is a disruption in the cortex of a bone, usually, but not always, caused by trauma. Fractures are considered to be open when disruption of the skin and underlying soft tissues results in a communication between the fracture and the outside environment.1 This can range from a subtle puncture wound to a grossly deformed limb with a large amount of bone exposed. It does not have to be a wound directly over the fracture site. A closed fracture does not have an overlying wound in communication with the fracture.
An open fracture is an orthopaedic emergency. As such, it is imperative that anyone who comes into contact with one is aware of the appropriate initial steps in its management.
In 1976, Gustilo and Anderson published their classification system of fractures.2 This system classifies fractures based on the size of the wound and any associated injuries, as set out