Compound (Open) Fracture Explained

Medically Reviewed By Angela M. Bell, MD, FACP
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A compound or open fracture is a broken bone with an open wound or a break in the skin at the site. Usually, the bone breaking through the skin causes the wound. But any fracture with a wound at the site is an open fracture, even if the bone did not cause the wound. Researchers estimate that 30.7 per 100,000 people experience a compound fracture annually. In males, compound fractures commonly happen between the ages of 15 and 19. In females, they typically occur between the ages of 80 and 89.

Arms, hands, legs, and feet are the most common sites of compound fractures. Approximately 45% of all open fractures occur in finger or toe bones, while the most common long bone fractures occur in the tibia and fibula of the lower leg.

Read on to learn more about what causes compound fractures, how doctors treat them, and how to prevent them.

What are the causes of a compound fracture?

A woman with a leg cast
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Compound fractures can result from what experts call high energy or low energy events.

High energy events may include car accidents or gunshot wounds. Falls or injuries from playing sports qualify as low energy events.

What are the symptoms of a compound fracture?

Compound fractures, like most fractures, are extremely painful. They may also cause other symptoms, including: 

  • wound that may or may not bleed
  • swollen limb or changes in its form
  • tenderness around the site
  • limb bruising
  • difficulty moving the affected area

How do doctors diagnose compound fractures?

The most common diagnostic test for a compound fracture is an X-ray. An X-ray will allow doctors to locate the break, determine how extensive it is, and see if there are any bone fragments. CT scans and other imaging tests may also be necessary.

Doctors will also assess:

  • damage to the soft tissues around the broken bone
  • blood supply in the area
  • type and amount of debris found in the wound, such as dirt, grass, or glass

Because compound fractures often occur along with significant injury to the affected area of the body, doctors may also perform blood tests.

What are the treatments for compound fractures?

To treat a compound fracture, doctors typically administer antibiotics immediately. Doing so can dramatically decrease your chances of developing an infection. You may also receive a tetanus shot if you have not had one in the past 5 years.

The doctors will stabilize and splint the fracture to prevent it from moving before surgery. A compound fracture almost always requires surgery to repair the break.  

During surgery, doctors will work on: 

  • cleaning the wound with a saline solution
  • removing any debris
  • repositioning and securing the bone with pins, rods, plates, or screws to stabilize and immobilize it

The surgery will involve either internal or external fixation, meaning that the method of stabilizing the bone — pins, rods, plates, or screws — will either go completely under the skin or extend past the skin to an external frame.

Doctors may immediately perform internal fixation if the:

  • wound is clean
  • damage to the skin or other soft tissue is minimal
  • bone pieces can easily realign through the doctors’ work

After internal fixation, the doctors will splint the broken limb or put it in a cast, and they will send you home with antibiotics to prevent infection.

External fixation may be necessary if the fracture or the wound is severe. Doctors will immobilize the limb with a metal or carbon fiber frame attached to the outside of the affected area. This type of fixation is beneficial if internal fixation cannot occur immediately.

If the compound fracture causes a large open wound that doctors cannot close, they may need to cover the wound with a skin graft or tissues from another part of the body.

What is the outlook for people with compound fractures?

The outlook for people with compound fractures depends on many factors:

  • location and severity of the break
  • amount of damage to the surrounding tissue
  • age of the person with the fracture, since children generally tend to heal faster than adults, for example
  • complications
  • other medical conditions slowing down the healing process, such as diabetes or peripheral vascular disease

The healing process begins immediately after the fracture occurs. The area will become inflamed as blood and immune cells rush to the injured area to start the healing process.

The repair stage is when new bone tissue grows to repair the bone. This stage can last a few weeks to months. Keeping the bone immobilized during the repair stage is crucial to promote healing.

Remodeling is the last stage of the healing process. The new bone grows thicker and hardens. This stage can last for several months.

People typically have stiffness, weakness, or discomfort for a while after a compound fracture heals. Physical therapy may be necessary to regain complete function in the limb.

Rarely, a compound fracture can be fatal if a large blood vessel is punctured, a vital organ is injured, or the bone becomes infected.

What are some potential complications of a compound fracture?

Complications of a compound fracture may include:

  • infections in the bone or surrounding tissue
  • damage to the muscles, nerves, tendons, or blood vessels
  • skin damage and scarring
  • joint and nerve damage
  • uneven limbs in a child or teenager
  • shock due to loss of blood and decreased blood pressure
  • pulmonary embolism, which occurs when a blood clot breaks off from the injured area and travel to the lungs
  • compartment syndrome, where blood and other fluids get trapped in one area of the injured limb

Can you prevent a compound fracture?

There are a few ways you can decrease your chances of experiencing a compound fracture:

  • Wear safety equipment when needed and proper shoes.
  • Install safety equipment in your home.
  • Use a cane or walker if needed.
  • Drive safely.
  • Avoid contact sports and heights.

Eating a balanced diet and exercising regularly can also promote bone strength and may help prevent fractures.

Summary

A compound or open fracture occurs when a bone break occurs with an open wound. Compound fractures commonly result from factors such as car accidents or sports injuries. In addition to pain, you may experience swelling, changes in the affected area’s form, and difficulty moving.

Doctors typically diagnose a compound fracture with an X-ray. Almost all compound fractures require surgery and immediate administration of antibiotics.

Get immediate medical treatment if you think you have a compound fracture or any other type of fracture. Prompt treatment will greatly reduce your chances of infection and other complications.

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Medical Reviewer: Angela M. Bell, MD, FACP
Last Review Date: 2022 Jun 21
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