8.1. Classification offractures and dislocations
Injury to bones and joints can be closed and open, complicated (when bone fragments or the displaced articular end of the bone are injured or squeeze large vessels, nerves, internal organs) and uncomplicated, isolated or multiple. Fractures are severe injuries, often accompanied by shock, blood loss and a threat of developing fat embolism.
Closed fractures or dislocations are those in which the skin is not injured.
Penetrating fractures are open fractures or dislocations, in which bone fragments or articular surfaces communicate with the external environment.
Penetrating wounds of the joints are all injuries with an open cavity.
Even if the fracture and the wound within the same segment have different localization with no obvious signs of communication of the wound with the fracture area, this fracture is still considered open (known as non-penetrating open fracture). This classification is of clinical importance, since development of possible wound complications even with a non-penetrating open fracture is likely to lead to infection of the affected area.
Every open fracture is bacterially contaminated, which can lead to development of infectious complications, which are noted in an average of 16% of cases. The more damage to the tissue in an open fracture, the more often there are purulent wound complications. In patients with an increased risk of developing wound infection, a set of preventive measures should be implemented at the very early stages.
It is necessary to distinguish between primary open fractures, in which bone and soft tissue injury occur simultaneously under the impact of traumatic force, and secondary open fractures, where the integrity of the skin is broken from the inside by the sharp ends of the bone fragments (Fig. 8.1). Victims with closed fractures can sustain injury to the skin in case of a secondary open fracture at improper immobilization, an attempt to shift the limb or inadequate therapeutic manipulations. Secondary open fractures also include cases where necrosis of soft tissues with gradual exposure of bone develops resulting from severe closed injury or pressure from internally displaced bone or tissue fragments.