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Communication with the environment causes fracture contamination; time-sensitive antibiotics, limb perfusion and orthoplastic management determine limb and infection outcomes.
Suspect an open fracture with any wound near a fracture, even a small puncture; examine and document distal perfusion, sensation and movement.
ABCDE, haemorrhage control, analgesia, sterile dressing, splinting and immediate orthopaedic/orthoplastic advice are priorities. Give prophylactic IV antibiotics immediately in ED per current local open-fracture policy.
Arrange appropriate radiographs, tetanus assessment and documented wound photographs under trust governance. Repeat and record neurovascular examinations after splinting or any deterioration.
Do not perform repeated wound exploration or routine ED washout of open long-bone/hindfoot/midfoot fractures; NICE recommends definitive wound care within the orthoplastic pathway.
UK reference: NICE NG37 complex fractures. Focused editorial source check, 7 November 2026; this is not independent clinical or pharmacy sign-off. Verify current local policy, BNF/BNFC and specialist advice before treatment. Not a prescribing protocol.
Related guides: General Basic Fracture management ยท Septic arthritis โ FY quick guide โ ๏ธ ๐ฅ