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1Introduction

Wound management

For open fractures, standard management of the wound will be according to local protocol, which will usually include:

  • Broad spectrum intravenous antibiotics given at first contact
  • Careful assessment and documentation of the neurovascular status of the hand
  • In the presence of significant vascular injury, immediate surgery with restoration of circulation should be conducted no later than 3-4 hours
  • Initial wound management involves removal of gross contamination to allow documentation (photography)
  • Wound is covered with a nonadherent gauze and waterproof dressing to prevent desiccation
  • The forearm is splinted using a backslab
  • Definitive wound management should be conducted, ideally with orthopedic and plastic surgical input, by complete excision of the injury zone (debridement)
  • Urgent surgery is required in all open fractures if the wound is heavily contaminated
  • Fracture stability is achieved using a simple external fixator