The early management of an open fracture sets up everything that follows, and the high-value steps are simple and time-sensitive. They are easy to delay when a department is busy.
Give intravenous antibiotics as soon as possible, ideally within an hour of injury, with cover guided by wound contamination, and check tetanus status. Remove gross contamination, photograph the wound once, then cover it with a saline-soaked dressing and leave it until theatre rather than repeatedly inspecting it. Realign and splint the limb, and document the neurovascular status before and after any manipulation.
Timing of debridement is guided by contamination and soft-tissue injury rather than a rigid six-hour rule, but antibiotics and a single clean dressing should not wait. Clear handover of the antibiotic time, tetanus status and neurovascular findings prevents these basics being missed between teams.
- Give intravenous antibiotics as soon as possible, ideally within an hour, and confirm tetanus status.
- Photograph the wound once, then cover with a saline-soaked dressing and stop repeatedly inspecting it.
- Realign and splint, documenting neurovascular status before and after manipulation.
- Let contamination and soft-tissue injury, not a rigid six-hour rule, guide debridement timing.
Why it matters
Early antibiotics and a single clean dressing do more to prevent infection than anything that happens later, yet are the steps most often delayed.
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