Debridement of Open Fractures

Indications

• All open fractures
• Within 12 hours for high energy injuries and 24 hours for others (BOAST 4)
• Immediately for gross contamination, compartment syndrome or vascular injury
• Gustilo and Anderson type helps guide antibiotics and coverage

Position

• Supine, tourniquet applied but inflated only if bleeding obscures the field
• Tourniquet on but not inflated

Operative Steps

1. Prepare the whole limb and photograph the wound
2. Extend the wound along fasciotomy lines
3. Excise dead skin, fat and fascia
4. Remove muscle that fails the four Cs, colour, consistency, contractility and capacity to bleed
5. Deliver and clean bone ends, remove loose fragments without soft tissue attachment
6. Irrigate with low pressure normal saline. Soap adds nothing (FLOW, NEJM 2015)
7. Stabilise with external fixation or definitive fixation if the wound is clean
8. Negative pressure or sealed dressing
9. Extend the wound along fasciotomy lines

Postoperative Care

• Antibiotics within one hour of injury and tetanus cover
• Relook at 48 hours if contamination remains
• Definitive soft tissue cover within 72 hours, ideally with definitive fixation
• Joint orthopaedic and plastic surgery planning
• Repeat debridement at 48 to 72 hours
• Definitive soft tissue cover within 7 days (BOAST 4)

Complications

• Deep infection and osteomyelitis
• Nonunion
• Flap failure and amputation
• Nonunion

Related Pages

• Open Fractures
• Pathologic Fracture

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.