The use of immediate internal fixation in open fractures.

Internal fixation of open fractures can be carried out according to the same indications employed in closed fractures in the presence of a type I wound. In type II and type III wounds early internal fixation may be indicated in victims of multiple trauma, in the elderly, in intra-articular fractures, in mutilated limbs, and in some fractures with associated vascular injuries. In these cases the higher risk of infection should be justified by the salvage of limb, life, or joint function. The risk of infection can be minimized by meticulous irrigation and debridement of the fractures, atraumatic surgical technique, and rigid fixation and by leaving the wound open.