Modern Management of Severe Open Fractures of the Extremities

➢ The administration of antibiotics, revascularization, effective initial debridement, stabilization, and dead-space management are important time-dependent, acute actions. ➢ Following the adequate resuscitation of the patient and the local soft tissues, the first stage of the Masquelet technique is performed together with the definitive coverage of the soft-tissue defect. ➢ The optimal time for the second stage (grafting of the bone defect) depends on the progress of the soft-tissue reconstruction and the overall state of the patient. It is usually at 6 to 14 weeks. ➢ Bone graft involves cancellous autograft; depending on the volume of the defect, it can be acquired using different donor sites and methods and can be combined with cancellous allograft, bone substitutes, bone marrow aspirate, and inductive molecules. ➢ Bone healing is independent of the size of the defect, assuming that revascularization of the graft material has not been disturbed. ➢ The development of signs of a fracture-related infection in the clinical setting of a severe open fracture dictates surgical treatment and pathogen-specific antibiotics, debridement of the membrane and the surrounding soft tissues, and reinitiation of the staged process of limb salvage. ➢ The results of staged management of severe open fractures with bone defects are reproducible and good.