Closed vs. Open Fractures & How They Should be Treated Differently

Doctors classify bone fractures into two main categories: closed and open. Closed fractures, sometimes called simple fractures, don’t involve a break in the skin. With open or compound fractures, the broken end of the bone protrudes through the skin, creating a wound. Open fractures take longer to heal and have a higher risk of infection and other complications. If you experience a fracture, the type of break will determine the type of medical treatment you need.

Symptoms of Open and Closed Fractures

If you have a fracture caused by an impact to your bone, the injured area may display redness, bruising, warmth, a deformed appearance, and swelling. You may experience pain and be unable to move the fractured part of your body. If you’ve injured your leg, foot, or ankle, you may be unable to walk on it.

You have an open fracture if you have a wound near the injury site. With this type of injury, the broken bone may even be visible through the damaged skin.

Treatment for Closed Fractures

Closed fractures don’t puncture the skin, and they often heal with conservative treatment. The most common types of closed fractures include breaks affecting the ankle, hip, or wrist bones. If you have spinal osteoarthritis, you may develop closed compression fractures in your vertebrae.

When you see your health care provider, they’ll use X-ray imaging to determine the extent of the break. They’ll also provide medication to help relieve the pain of your fracture injury. Although a closed fracture may need surgical correction, the risk of infection is much lower than with an open fracture, so you won’t necessarily need to have an immediate procedure.

Immobilizing the Injury

If the broken bone has remained in place, your doctor may recommend a cast or splint to immobilize the fractured area. With this approach, it typically takes about a month for the fracture to heal with a split or about two months with a cast. You’ll have follow-up appointments with your health care provider so they can monitor the healing with X-rays.

Reducing Displaced Bones

If you have a displaced fracture in which the bones have shifted out of place, your doctor will perform an alignment procedure called a closed reduction before splinting or casting the injured area. You’ll receive general or local anesthesia for closed reduction. Then, the doctor moves the bones into place from the outside of the injured body part.

Treatment for Open Fractures

Open fractures most often affect the arms, legs, feet, or hands. They usually result from severe trauma, such as getting injured while playing contact sports, falling from a significant height, or getting in an auto accident. An open fracture has occurred whether just a small fragment or a large segment of the bone punctures the skin, so there’s a wide range of severity.

A wound of any size can become infected, so you need to seek medical treatment right away. As with a closed fracture, your health care provider will perform imaging tests on the injured area and give you medication to alleviate the pain of the injury.

First, the physician will clean bone fragments, damaged tissue, dirt, bacteria, and any other debris from the wound. After your doctor has sanitized the injury site and realigned displaced bones, they may perform surgery to stabilize and repair the broken bone. They’ll also repair damage to muscles, tendons, blood vessels, and other soft tissue around the wound.

Depending on the type of injury, your health status, your preferences, and other factors, you may be a candidate for one of several different types of fracture surgery.

External Fixation

You may need external fixation if your fracture needs to heal enough to support internal fixation. In this procedure, the doctor connects the fractured bone parts with internal screws that attach to an external frame.

Internal Fixation

This procedure involves the placement of internal surgical hardware to hold together broken bones. Your surgeon may use metal wires, pins, screws, plates, or rods. These devices keep your bones in the right place so they can heal properly. You may need a second surgery to remove the hardware, or it may remain in place. After internal fixation, you need to avoid using the injured part of your body until the bone fully heals.

Arthroplasty (Joint Replacement)

You may need this type of surgery if you fracture your knee, elbow, shoulder, or another joint. The doctor replaces the injured part of the bone with a prosthetic component made of surgical-grade plastic, ceramic, metal, or a combination of these materials. Prosthetic joints are designed to work like actual joints. Depending on the extent of the damage, your surgeon may recommend a partial or total joint replacement.

Bone Graft

If you have a severely displaced bone, your surgeon may recommend a graft to help the injured bones heal properly. They may use a graft made from artificial bone, a donor bone graft, or a graft from the top of your hip bone or another bone. Like with other types of fracture repair surgery, you’ll need to keep the bone immobile and refrain from using it while it heals. Your doctor will prescribe a sling, brace, splint, or cast.

Other Treatments

Some compound fractures require traction. With this type of treatment, the doctor stretches the muscles and tendons around the injured area. They’ll use a system with a metal frame, weights, and pulleys. This method facilitates proper healing and alignment of a serious fracture.

See a Hand and Wrist Specialist for Fracture Care

If you experience an injury and think you may have a broken bone, don’t wait to get medical care. The Hand and Wrist Institute has the specialized care you need for fractures impacting the delicate bones and soft tissues of the upper extremities. We have three convenient locations and practice at two surgical centers in the Dallas and Frisco areas. Contact us today to schedule an appointment with one of our board-certified orthopedic physicians.


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Dr. John Knight
Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.