You are here

Open Fracture


Open Fx ICD-9 / CPT

  • ICD-9: Depends on associated fracture
  • CPT 11010: debridement includinge removal of foreign material; open fracture/dislocation; skin and subcutaneous tissue
  • CPT 11011: debridement includinge removal of foreign material; open fracture/dislocation; skin, subcutaneous tissue, muscle fascia and muscle
  • CPT 11012: debridement includinge removal of foreign material; open fracture/dislocation; skin, subcutaneous tissue, muscle fascia, muscle and bone.

Open Fx Etiology / Epidemiology / Natural History

  • Greater risk of infection and take longer to heal than comparable closed fractures.

Open Fx Anatomy

Open Fx Clinical Evaluation

  • Photograph the injury.

Open Fx Xray / Diagnositc Tests

  • Consider intrarticular sterile normal saline injection to distinguish superficial lacerations / abrasions from open wounds associated with joints. Injection must be done outside zone of injury and with large fluid bolus (50ml for knee).
  • Evaluate for compartment syndrome.

Open Fx Classification / Treatment

  • Gustilo-Anderson Classification
    -Grade I: <1cm
    -Grade II: >1cm
    -Grade IIIa: >10cm
    -Grade IIB: requiring local or free flap coverage of the exposed bone
    Grade IIIC:vascular injury requiring repair .
  • Classifaction has poor interobserver agreement (Brumback RJ, JBJS 1994;76A:1162).
  • IV antibiotics should be given as soon as possible. Generally Cefazolin 2 g IV Q8hrs +/- Levaquin 500mg IV QD depending on wound contamination. Historical recommendation is cefazolin +/- gentamycin. Gentamycin increases renal failure risk. Add penicillin for any wound heavily contaminated with soil.
  • Antibiotic duration is 3 days for grade I and II open fx; 5 days for grade III.(Wilkins J, Orthop Clin North Am 1991;22:433).
  • Tetnus vaccinationshould be given if last vaccination was > 10yrs prior or unknown. If wound is severely contaminated give vaccination in vaccination was >5yrs prior.
  • Photograph the injury.
  • Operative debridement should be done in a timely fashion. Exact timeline is unknown. Most important factor is when IV antibiotics where given. Associated lacerations should be extended to inspect entire zone of injury. Irrigate with low-pressure lavage (high-pressure may drive contamination into soft tissues).
  • Consider wound VAC and/or antibiotic beads. Antibiotic beads made with polymethyl methacrylate impregnated with vancomycin or tobramycin.
  • Exteral fixation vs internal fixation vs traction depending on fracture type and severity of soft tissue injury.
  • Initial wound closure remains controversial. Recent OTA study on 415 patients with open tibial shaft fractures noted no difference in infection/union between delayed or initial closure with adequate debridement.
  • Consider 4th generation cephalosporin for open fractures with pond or stream water contamination. Prophylaxis against Aeromonas.
  • Open fracture Debridement CPT codes: 11010(skin, subq), 11011(skin, subq, muscle, fascia), (skin subq, muscle, fascia, bone)

Open Fx Associated Injuries / Differential Diagnosis

Open Fx Complications

Open Fx Follow-up Care

  • Early soft tissue coverage indicated when soft tissues permit. May require repeated I&D's before wound is completely free of debrie and non-vialbe tissue.
  • See Flaps for coverage options.

Open Fx Review References

Rockwood and Green's Fractures in Adults 6th ed, 2006


The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer