[Update on the Initial Management of Open Fractures for General Practitioners and Specialists: A Scoping Review of the Literature].

UNLABELLED: Open fractures represent a significant public health burden due to the high risk of infection, sequelae, and mortality. Initial management is crucial to prevent or reduce these complications.

AIM: Describe the current options for initial management of open fractures in the emergency department by general practitioners and specialists.

METHODS

A scoping review of open fracture management was conducted between October and November 2024, using MESH terms in PubMed and SCIELO in English and Spanish. Articles from the last 5 years (2019-2024) were included that address the pillars of emergency department management: early antibiotic therapy, pain management, immobilization, and debridement.

RESULTS

Of 2,883 articles retrieved from PubMed and SCIELO, 30 studies were included. The mainstays of treatment remain as follows: early antibiotic therapy, pain management, immobilization, and debridement.

DISCUSSION: Antibiotic therapy should be early, ideally within 60 minutes. Surgical cleaning within 24 hours of the injury according to the fracture characteristics. Early wound closure and pain management associated with alignment and immobilization and/or fixation. Furthermore, the use of local antibiotic therapy or vacuum-assisted-closure (VAC) by the specialist should be considered.

CONCLUSIONS

General practitioners should know the timing of antibiotic administration and debridement, should manage pain with medications and immobilization of the fracture, and prescribe tetanus prophylaxis as needed. The specialist should ensure surgical cleaning and wound closure, considering the use of local antibiotics such as VAC to improve the patient's prognosis. Up-to-date and protocol-based management of this condition is important for preventing morbidity and mortality.