A compound fracture of the ankle or foot occurs when a broken bone injury is severe enough that a bone fragment or the end of a broken bone sticks out through the skin or is otherwise exposed to the open air and/or visible to the naked eye. This kind of injury is also known as an open fracture.
What Causes A Compound Fracture?
A compound or open fracture is always a result of trauma, usually caused by a severe direct impact such as may occur in an auto accident or a fall from a great height. In some cases, however, an open fracture can occur from a twisting type of injury if enough force is involved.
There are a number of ways this could happen: for example, if someone were to step into an unseen hole in the ground while playing football, and if someone else were to tackle that person while they were stuck in that hole, the resulting twisted ankle injury might occur with enough force to result in a compound fracture of the ankle.
What Are The Complications of a Compound Fracture?
Because extraordinary force must be applied to the bone to cause an open fracture, these types of injuries frequently are accompanied by other injuries elsewhere on the body (again, consider what happens in a serious automobile accident).
Between 40 and 70 percent of compound fractures occur in association with traumas to other parts of the body.
The most common complication associated with compound fractures, however, is infection. Because the skin has been broken—and in many cases there is considerable bleeding—an open fracture presents an opportunity for bacteria to enter the bloodstream, leading to infection and possibly to conditions such as septic arthritis.
If the infection is not stopped in time, it may even become necessary to amputate the affected foot.
There is also the possibility of wound contamination from environmental debris or chemicals, such as dirt, gravel, sand, or motor oil.
Compound fractures tend to involve injury not only to the bone, but also to the tissue surrounding it, and for this reason they can take much longer to heal than a normal broken foot or broken ankle.
The bone itself also heals more slowly than it would if it had suffered a closed fracture of comparable severity. This is because an open fracture damages the periosteum, a layer of tissue that envelops all of our bones.
Finally, a compound fracture can sometimes cause the affected person to develop a painful and dangerous muscle condition known as compartment syndrome, which is characterized by a buildup of pressure in the muscle tissue caused by swelling and inflammation at the site of the injury.
How is a Compound Fracture Diagnosed?
Diagnosis of a compound fracture is usually not difficult—the nature of this type of injury makes it immediately obvious in most cases.
However, there are times when a compound fracture is not apparent. It is possible for an injury to break a bone while creating a flesh wound that reaches all the way down to the bone but is no more than a few millimeters in diameter.
An open fracture, by its nature, is almost always treated in the emergency room. If you suffer this type of injury, the ER doctor who examines you will look closely at the wound to assess the damage that may have been done to your nerves and blood vessels.
You will immediately be given antibiotics, and if you have not had a tetanus shot within the last few years, you will get one now. X-rays will be taken, possibly to be followed by MRI (magnetic resonance imaging).
These imaging tests will show the doctor how complex the break is, how badly displaced the bones are, and what damage may have been done to the surrounding tissue.
How is a Compound Fracture Treated?
As noted above, antibiotics must be administered as soon as possible. The next step after this is debridement and irrigation. This involves removing any debris that remains in the wound, as well as any unattached bone fragments, and then washing the wound thoroughly with saline solution.
Once this is done, the broken ends of bone must be stabilized to prevent further injury to the surrounding tissue. This requires one of two surgical procedures—either internal fixation or external fixation—depending on the nature and severity of the injury.
External fixation is a way of holding the bones in alignment by inserting pins or screws into the bone above and below the place where the break occurred. These pins or screws are connected to a metal stabilizing frame outside the skin, which keeps the bones in their proper position.
Internal fixation involves attaching screws or metal plates to the surface of the bones; this will only be done if there is no infection. Rods may also be inserted through the marrow space inside the bone to hold the broken ends together. This procedure allows for a more precise realignment of the broken pieces of bone, but it is not always possible to perform internal fixation right away.
The doctor must consider whether the patient is stable, whether he or she has suffered other, more serious injuries in the accident that caused the open fracture, and whether the patient is ready to tolerate this kind of surgery.
