What is the difference between an open vs. closed fracture?

First of all, fractures are common injuries that can occur due to various reasons, such as accidents, sports injuries or underlying medical conditions. And when it comes to a fractured bone, it is broadly categorized into one of two main types: closed fractures and open fractures. Understanding the differences between which type of fracture you have is crucial for proper diagnosis, treatment and recovery.

Closed fractures: the hidden damage

“Closed fractures, also known as simple fractures, occur when a bone breaks but does not penetrate the skin,” Spencer Romine, MD, an orthopedic surgeon at Mercy Health – Western Kentucky Orthopedics explains. “Although these types of fractures don’t usually require emergency medical treatment, you still need to find help quickly. Without care, these injuries can cause fluid-filled sacs, called fracture blisters, to develop in the surrounding tissues, and those blisters can result in a bone infection.”

Identifying a closed fracture can be challenging without proper medical evaluation, especially if there are no visible signs of external injury. However, there are common symptoms associated with closed fractures.

These common symptoms include:

• Pain: The most common symptom of any fracture is pain at the fracture site. This is common with a stress fracture, and the intensity of pain can vary depending on the severity and location of the fracture.
• Swelling: Swelling and bruising may occur around the injured area due to damage of the soft tissues as well as inflammation.
• Deformity: In some cases, a closed fracture may cause a visible deformity or abnormal alignment of the affected limb or joint.
• Limited mobility: Fractures can restrict normal movement, leading to difficulty in using the injured part of your body.

Diagnosing a closed fracture typically involves a physical examination, medical history review and imaging tests, such as X-rays, CT scans or MRI scans. Once diagnosed, treatment aims to realign and stabilize the fractured bone to promote healing.

Common treatment approaches for closed fractures include:

• Immobilization: Using a brace, splinting or casting are ways to immobilize the injured limb and prevent further damage.
• Reduction: In cases of displaced fractures, manual or surgical reduction may be required to realign the bones.
• Pain management: Pain relievers and anti-inflammatory medications are prescribed to manage pain and reduce swelling.
• Physical therapy: Rehabilitation exercises help restore strength, flexibility and function to the injured area once the fracture begins to heal.

Open fractures: the risk of infection

Unlike closed fractures, open fractures involve a break in the skin, leading to direct exposure of part of the bone to the external environment. Open fractures are considered more severe and carry a higher risk of complications, such as infection, due to the breach in skin integrity. These fractures often result from high-energy trauma, such as severe falls, motor vehicle accidents or gunshot wounds.

Open fractures present with symptoms that include those of closed fractures along with additional signs related to the open wound.

These signs are:

• Visible wound: An open wound or laceration at the fracture site is visible, exposing the broken bone. This is also known as a compound fracture.
• Bleeding: Open fractures may cause significant bleeding, depending on the severity of the injury and involvement of blood vessels.
• Risk of infection: Due to the exposure of bone and surrounding tissues, open fractures are at high risk of developing infections, leading to complications.

Immediate medical attention is crucial for open fractures to reduce the risk of infection and promote optimal healing. Diagnosis involves assessing the extent of the injury through physical examination, imaging studies and evaluating the risk of associated injuries.

As far as treatment options for open fractures, those include:

• Wound cleaning: Thorough irrigation and cleaning of the wound to remove debris, dirt and bacteria are essential to reduce infection risk.
• Antibiotics: Broad-spectrum antibiotics are often administered intravenously to prevent or treat potential infections.
• Surgical intervention: An open fracture requires surgery usually to debride the wound, realign fractured bones and stabilize them using internal fixation devices such as plates, screws or rods.
• Wound closure: Depending on the severity and contamination of the wound, primary closure or delayed closure techniques may be employed.

Both closed and open fractures can lead to various complications, including delayed healing, improper bone healing leading to deformity, failure of bone fragments to heal, increased pressure within muscles and post-traumatic arthritis. Long-term management of any type of fracture involves regular follow-ups with health care providers, adherence to rehabilitation programs and lifestyle modifications to support bone health and prevent future injuries.

Understanding the differences between an open vs. closed fracture is essential for prompt recognition, appropriate treatment and optimal outcomes.

Learn about the orthopedic services we provide at Mercy Health.