MANUAL MINORS
Compound fractures of the toes, also known as open fractures, occur when the fractured bone pierces the skin, exposing bone fragments to the external environment. These injuries are serious due to the high risk of infection and damage to surrounding soft tissues, such as muscles, tendons, and nerves. They typically result from high-energy trauma, such as crushing injuries or heavy objects falling on the foot.
Diagnosis
Diagnosis is based on the visual assessment of the fracture, where the broken bone is visible through an open wound in the skin. The patient experiences intense pain, bleeding, swelling, and obvious deformity of the affected toe. X-rays are essential to evaluate the fracture pattern and the condition of the bone fragments. Additionally, the possibility of infection should be considered, and laboratory tests may be needed if signs of sepsis are present.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Closed toe fracture | No bone exposure; the broken bone remains beneath the skin. |
Toe dislocation | Joint displacement without bone fracture or exposure. |
Severe toe sprain | Ligament injury without bone fracture or exposure. |
Secondary wound infection | Open wound with signs of infection but no underlying fracture. |
Emergency Management
The emergency management of a compound fracture is an orthopaedic emergency. Immediate control of bleeding with sterile dressings and copious irrigation of the wound is required to reduce infection risk. Intravenous antibiotic prophylaxis is administered, and the patient’s tetanus vaccination must be updated.
Reduction of the fracture may be performed in the emergency department under sedation or anaesthesia, but if the tissues are severely damaged, urgent surgery is required. The affected toe is immobilised with a splint or orthopaedic shoe, and the patient is prepared for surgery.
Definitive Treatment
Definitive treatment includes surgical debridement of damaged tissues to remove contaminated material and foreign bodies, followed by stabilisation of the fracture with internal fixation (screws or plates) or external fixation, depending on the severity.
Wound cleaning and closure must be performed with extreme care to prevent infection. Postoperative follow-up includes close monitoring for signs of infection, prolonged antibiotic therapy, and, if necessary, additional surgeries to repair soft tissue or correct deformities.
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