Imagine that you suddenly fall off a ladder or have a car accident. At that moment, you look up with extreme pain and see a broken piece of bone sticking out through the skin of your arm or leg. In fact, anyone who sees something like this gets very scared. They get worried. In medicine, we call this condition a Compound Fracture or an Open Fracture . This is a very serious condition and you should go to the hospital immediately.
Simply put, what is this Compound Fracture?
The main reason for a bone to break, or as we call it, a fracture, is an excessive force applied to it. This can happen from something like an accident. But sometimes it can also be due to continuous pressure applied to the same place. For example, when a soldier constantly walks with a heavy backpack on his back, the continuous pressure on the leg can cause a small crack in the bone.
Now let's look at what a "Compound" or "Open" Fracture is. Simply put, this is when the broken bone is visible through your skin. If you fall off a ladder and break your arm, and the broken bone is visible through the skin, it is a Compound Fracture. However, if the bone is broken but the skin is intact, meaning the broken bone is not visible, we call it a "Simple" or "Closed" Fracture.
A compound fracture is a serious condition that causes extreme pain and is frightening to look at. Therefore, one should immediately go to the Emergency Department (ETU) of the nearest hospital without any hesitation.
Which bones in the body are most susceptible to this injury?
Any bone in our body can break. However, compound fractures are most common in our arms, legs, hands, and feet. In addition, there are other bones that can also be affected, albeit at a relatively low rate.
- Ribs
- Collar bone
- Eye bones
- Pelvis
- Skull bones
- Face bones
- Spine or vertebrae
What are the main causes of a compound fracture?
For a serious fracture like this to occur, there must be a significant blow or impact (Severe Trauma) to the body. For example:
- Serious car accident
- A fall from a considerable height
- An accident that occurs in a contact sport such as football or rugby
What are the symptoms of this?
The main and most obvious symptom is the broken bone protruding through the skin. In addition, there are several other symptoms that can be seen. Let's look at them clearly in a table.
| Symptom | Description |
|---|---|
| The exposed bone | This is the most obvious sign. The broken bone is visible through the skin. |
| Severe, sharp pain | There is severe, unbearable pain. |
| Sensitivity to touch | The area around the wound is painful to touch. |
| Swelling and bruising | The area around the wound may become swollen and turn a blue-purple color. |
| Bleeding | The wound is bleeding because the skin has been pierced. |
| Nerve damage | Sometimes, due to nerve damage, the pain may be less or more than expected. Or you may feel numbness. |
How does a doctor diagnose and treat this?
It's not that difficult for a doctor to diagnose a compound fracture. Because the broken bone is visible through the skin. But doctors don't just diagnose it and wait. They will definitely do an X-ray to see exactly how the bone is broken, how much damage is done, and how it needs to be repaired. Sometimes, tests like an MRI or CT scan may be needed to study the damage in more depth.
In addition, doctors also check for other complications:
- Check your skin color and temperature (learn about blood supply).
- They check blood pressure and pulse to see if there is excessive bleeding.
- Sensation is tested in the areas around and below the wound to see if there is any nerve damage.
Treatment methods
When you are brought to the Emergency Department (ETU), the first thing that is done is to control the pain. This is done by giving you oral painkillers, or intravenous painkillers for quick relief. Sometimes, an injection is given to the nerves around the wound to numb the area. This is called a Nerve Block .
Depending on the nature of the wound, a tetanus shot and antibiotics are also given to prevent infection.
Next, the bone is realigned and the necessary steps are taken to heal it. This requires surgery. During surgery, the doctor will give painkillers and anesthetics, and then move the broken bone fragments back to their correct positions. We call this reduction of the fracture .
To hold the bones in the correct position, various instruments are used during surgery:
- Pins
- Rods
- Plates
- Screws
After the bones are prepared in this way, a cast or other device is used to immobilize the part to prevent movement.
How does a broken bone heal?
Our bodies have an amazing ability to build new bone tissue. When a bone breaks, new bone tissue begins to grow around the broken bone. We call this External Callus . At first, it is soft, like jelly, but over weeks and months, it gradually hardens, deposits calcium, and becomes normal bone.
This healing process occurs in three main stages:
1. Inflammation stage
As soon as a bone is broken, the body begins the healing process. Immune system cells rush to the site of the injury and increase blood flow to the area. This is why the area around the injury becomes swollen and red.
2. Repair stage
This stage can last from a few weeks to a few months. During this time, your broken bone is immobilized with a cast. During this time, the body forms what we called the External Callus . This is very delicate, so it is very important to protect it.
3. Remodeling stage
This can take several months. During this time, the newly formed bone tissue (callus) thickens, calcium deposits, and becomes stronger. Gradually, the bone returns to its normal shape and strength.
What complications can this cause?
A compound fracture is a complex injury. Therefore, various complications can sometimes occur. Doctors are constantly aware of this in the ETU, during surgery, and during the recovery period.
| Complication | Simple explanation |
|---|---|
| Common complications | |
| Skin damage | The skin is damaged when the bone comes out. The wound heals as the bone heals. |
| Damage to joints | If the fracture occurs near a joint, the movement of the joint may be affected. The joint may become immobile. This can be restored with physical therapy. |
| Nerve damage | A broken bone can crush, cut, or pull nerves. These often heal, but it can take months or years. |
| Healing problems | Sometimes bones may not come back together (nonunion), heal slowly (delayed union), or heal incorrectly (malunion). |
| Uneven growth of children | Children's bones have growth plates at the ends. If these are damaged, that bone can become shorter than the other side. |
| More serious (but uncommon) complications | |
| Infection | The wound is open, allowing germs to enter. Fever and foul odor while the plaster is still in place are signs of infection. Seek immediate medical attention. |
| Pulmonary Embolism | A blood clot can form in a vein near the fracture and travel to a vein in the lung and become lodged. If you suddenly have difficulty breathing, this can be life-threatening and requires immediate treatment. |
| Bone death (Osteonecrosis) | If the blood supply to the bone is cut off, the bone can die. |
| Compartment Syndrome | Excessive swelling of the muscles around the wound can compress blood vessels and cut off blood flow. This is a very dangerous condition. If you experience excessive swelling, severe pain, or numbness, notify your doctor immediately. |
How long does it take to heal?
A compound fracture can take several months or longer to fully heal. It is important to be patient during this time. The healing time depends on several factors:
- The severity of the injury.
- Your age (children recover more quickly than adults).
- Complications after treatment.
- If you have other medical conditions, such as diabetes, recovery may be delayed.
How to care for a cast?
Taking good care of your cast is important for it to heal quickly. Here are some tips:
- Unless your doctor has given you permission, do not let the plaster get wet. If it gets wet, it will be difficult to dry and may cause skin wounds or infections.
- Check the skin around the plaster regularly. Tell your doctor if it becomes red, oozes fluid, or is painful.
- For the first 24-48 hours, keep your arm/leg elevated above your heart with pillows as much as possible. This will help reduce swelling.
- If the skin inside the plaster is itchy, don't put anything inside to scratch it.
- To reduce swelling, it's fine to move your fingers if your doctor has given you permission.
- If the edges of the plaster are rough or sharp, apply a plaster or tape to prevent injury to the skin.
When you have a cast on, under what circumstances do you need to go to the ETU quickly?
If you have a cast on your body, be very careful of the following symptoms. If you have any of these, go to the emergency room immediately.
- If the plaster makes your arm/leg numb .
- If you feel like your arm/leg is getting weak .
- If the pain persists or increases .
- If the plaster feels too tight .
- If there is a strong odor coming from the plaster.
- If you have a fever .
Take-Home Message
- A compound fracture is a serious condition in which the skin is broken and the bone is exposed.
- In the event of an accident like this, do not panic and take the patient to the nearest hospital's Emergency Treatment Unit (ETU) as soon as possible.
- Never try to push the bone back in or clean the wound. Covering the wound with a clean cloth is sufficient.
- It is very important to be patient and follow medical advice, as the healing process can take several months.
- Proper care of the cast and proper physical therapy are essential for a speedy recovery.
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