Compound Fracture

What is a compound fracture?

A compound fracture is a break or crack in your bone that is visible through your skin. Generally, bones break as a result of force and/or trauma like a car crash. Fractures can also be caused by less traumatic but repeated force. For example, if a soldier frequently marches with a heavy pack on their back, the repeated force on their leg could cause a crack in their fibula.

What makes a fracture “compound” or “open” is when the broken bone pierces your skin. If you happen to fall from a ladder and land on your arm, breaking it, you’ll know it’s a compound fracture if you can see the bone. “Simple” or “closed” fractures don’t break through your skin.

Compound fractures are extremely painful. It may also be frightening to see your bone exposed. A fracture is a serious injury, and you should immediately go to the emergency department for help.

Which bones can fracture?

Any bone in your body can break, but compound fractures most commonly occur in your limbs (arms, hands, legs and feet). Less commonly broken bones include:

• Ribs.
• Collar bone.
• Eye bones.
• Pelvis.
• Skull bones.
• Face bones.
• Spine or vertebrae.

What causes compound fractures?

Severe trauma causes compound fractures. Examples of events that can cause this type of severe trauma include a:

• Car crash.
• Fall from a significant height.
• Contact sport like football.

What are the symptoms of a compound fracture?

A broken bone is a compound fracture if it breaks through your skin. You can see the broken bone. Additional symptoms include:

• Severe, sharp pain.
• Tenderness to touch.
• Swelling.
• Bruising.
• Bleeding.
• Nerve damage, which may make the pain less or more severe than expected.

How is a compound fracture diagnosed?

A compound/open fracture is more obvious to a healthcare provider than a simple/closed fracture because your bone has broken through your skin. The healthcare provider will do a physical examination and then order X-rays to see exactly how the bones are broken and how they need to be aligned. Sometimes healthcare providers require a more sensitive test, like an MRI (magnetic resonance images) or a CT scan (computed tomography) to fully assess the damage from the fracture.

Your healthcare provider will check for complications in addition to diagnosing the compound fracture itself. They’ll do the following:

• Check the color and temperature of your skin.
• Check your pulse and blood pressure to be sure there is no significant bleeding.
• Check for nerve damage by examining the area around and beyond your injury.

What healthcare providers diagnose compound fractures?

Compound fractures are obvious fractures. If you’re taken to the hospital by ambulance after the fracture, the healthcare providers in the ambulance will be able to diagnose it. Whether or not you need an ambulance, you should always go to the nearest emergency department where healthcare providers will diagnose the compound fracture and plan your treatment.

What is the treatment for a compound fracture?

When you get to the emergency department you’ll get one or more pain relief options, including:

• Multiple possible pain medications by mouth, or directly into a vein for faster relief.
• Nerve block. A nerve block is a numbing medicine that’s injected straight into the nerves around the area.

You might also get a tetanus vaccine and antibiotics, depending on what caused your injury and/or the location and severity of the fracture.

Treatment for your compound fracture is summed up by the acronym P.R.I.C.E.:

• Protection: Before you go to the hospital, you should cover the open fracture with a clean, wet towel to avoid getting dirt inside it. You should also avoid using any of the joints near the break unless absolutely necessary to get help.
• Rest: You’ll heal faster and be less likely to cause more injury if you rest the body parts.
• Ice: You should ice above and around the compound fracture as soon as the injury occurs, but be careful not to contaminate the actual wound.
• Compression: Your limb or other body part will be held in place for healing with a cast or other device.
• Elevation: Elevate (raise) the injury above your heart to reduce the swelling. You may need to wait until after being seen in the emergency department to do this, depending on where the broken bone is located. Check with your healthcare provider.

You’ll then need to see a surgeon, who will need to move each of the fractured bones back into a regular, more normal position. This is called reduction of the fracture. You’ll get pain relievers, sedatives and/or anesthesia before the procedure.

During surgery your bones may be aligned using hardware devices, including:

• Pins.
• Rods.
• Plates.
• Screws.

Your bones will then be immobilized in a cast or other device.

How do compound fractures heal?

Your bones heal by creating new bone tissue. The new bone is called the external callus. This callus begins to form shortly after the bone is broken. At first it’s not like normal bone — it’s soft and does not provide any protection for the underlying break. But it grows stronger as it calcifies and develops into normal bones over weeks to months.

Compound fractures heal in three stages:

• Inflammation.
• Repair.
• Remodeling.

Inflammation stage: Your body starts to heal right after the fracture. The cells of your immune system rush to the injured area instantly. One of the things they do is increase blood flow to the area, and that can cause the skin around the compound fracture to swell and turn red. This swelling and redness can continue for some time as your body tries to ensure healing.

Repair stage: During this stage — which can last from weeks to months — your fractured bone will be kept still (immobilized) in a cast. It’s vital that your broken bones don’t move while they heal. Your body will create new bone tissue during this stage. The external callus (the new bone) can be easily damaged, so it needs protection.

Remodeling stage: The remodeling stage can take several months. During this time, the external callus gets stronger because it grows thicker and calcifies. As your bones remodel, they become a more normal shape and are less fragile.

Is a compound fracture curable?

Compound fractures can often be fully repaired through surgical correction of the deformity, along with care for the broken bone and the wound that it caused.

Are there any complications of a compound fracture?

Compound fractures are complicated injuries, but not all of them cause long-term complications aside from the actual broken bone. Your healthcare providers will check for them when you’re in the emergency department and in surgery, and also during your recovery process. Complications that may occur after a compound fracture include:

• Skin damage: The compound fracture injures your skin when it pierces it. Your skin will heal while the bones heal. Skin under the cast doesn’t require special treatment while the cast is on, but may need some care after the cast comes off.
• Joint damage: If your compound fracture is close to a joint, it can impact that joint’s ability to move properly. The break can damage the cartilage at the ends of your bones and joints can also become stiff when bones are immobilized. You will need to do physical therapy to get the joint moving properly and surgery is sometimes necessary to get the joint back to normal movement.
• Nerve damage: A compound fracture can crush, bruise, tear or stretch your nerves and it’s likely that you will have some mild nerve injury. These may completely heal, but it can take months (and sometimes years). Depending on the amount of damage, there are some nerve injuries that can’t heal, but these are less common than milder injuries.
• Healing problems: In some instances the bones don’t grow back together (nonunion). Sometimes they grow back slower than normal (delayed union) and sometimes they grow back in the wrong position (malunion). Your healthcare providers will take X-rays to check on how well you’re healing and let you know whether other treatment is necessary.
• Uneven limbs: Kids’ bones are still growing until their teen years. There are portions of the bones, near the ends, that are called growth plates. This is where kids’ bones get longer. If a growth plate in your child’s arm or leg is damaged, that bone may not grow normally and end up shorter than the other side. Your healthcare provider will tell if you if a growth plate has been damaged.
• Shock: You may lose a lot of blood when you experience a compound fracture, which can be very scary. The blood loss might be external or internal, meaning that you may see blood from the injury or you may just see swelling as the blood is trapped under the skin. Blood loss can drop your blood pressure suddenly and severely, sending you into shock.

More severe complications include:

• Infection: If you have a fever or there’s a strong smell coming from your cast, you might have an infection. You should treat any possible infection after a compound fracture like an emergency and get care immediately.
• Pulmonary embolism: A pulmonary embolism is a blood clot in a vein near the fracture area, which can travel to an artery in your lung, and block it. This happens most often after a compound fracture in the pelvis or hip. If you feel suddenly short of breath after a significant fracture you need to get treatment emergently because pulmonary embolism can be fatal.
• Osteonecrosis: Osteonecrosis is when your bone dies because of interrupted blood flow. If this happens, your provider will find it on X-ray and tell you how it needs to be treated.
• Compartment syndrome: Any significant swelling of muscle or other tissue around the bone can press against your blood vessels. This pressure can slow or stop the blood from flowing in and out of the area. Tissues get damaged or may die, which can lead to the need for amputation of the dead tissue. Infections can set in if you develop a compartment syndrome. This infection should be treated quickly and appropriately or they can be very dangerous and possibly even fatal. Always tell your healthcare provider if you see any unusual swelling or notice an unexpected loss of sensation — or anything that concerns you after treatment for a compound fracture.

How long does it take to recover from a compound fracture?

Compound fracture recovery time can be several to many months. It’s important to be patient during the healing time.

A number of factors affect how quickly you may recover from a compound fracture. Factors include:

• The severity of your injury.
• Your age. Children, for example, heal quicker than adults.
• Complications after treatment.
• Other health issues. If you have a disorder that interferes with blood flow, you may heal slower. Examples of such disorders include diabetes and peripheral arterial disease.

What happens if I don’t get treatment for a compound fracture?

A compound fracture is a very serious injury. It’s not something you should ever try to fix on your own. See a healthcare provider at an emergency department as soon as possible for the best care. If you wait too long to get treatment then there’s a higher likelihood of complications.

What can reduce my risk of a compound fracture?

Accidents can happen to anyone. It’s scary to think you could break a bone by falling off a ladder, getting into a car crash or slipping on a wet floor. You can reduce your risk by taking simple precautions such as:

• Avoiding heights.
• Doing yoga or other exercises to improve strength and balance.
• Holding on to safety bars when you get in and out of the bathtub if you don’t have great balance.
• Driving safely and defensively.
• Not playing contact sports like football.
• Being careful if the ground is slippery, and wearing the proper shoes for the surfaces you’re walking on.
• Using a cane or walker if recommended by your healthcare provider.

What’s the outlook for people with a compound fracture?

This depends on the actual injury. After your compound fracture heals it will still be seen on X-rays, but you may not be able to tell just by looking at the area. The bone tissues often meld together pretty well. Your bones’ abilities to function should return to their normal usage like before your injury, depending on the severity of the break. You may need a lot of physical therapy to get back to your normal activities.

How do I take care of my cast?

Taking proper care of the cast immobilizing your bones is vital for the healing process. Keep the following tips in mind for proper cast care:

• Don’t let your cast get wet unless your provider says it’s OK. If the cast isn’t waterproof, it’s difficult to get it dry again. A wet cast can lead to sores or infection, so use a plastic bag or waterproof cover made to protect casts. Sometimes the cast can fall apart — if this happens it should be replaced immediately.
• Check the skin around your cast often. If you see redness or drainage, or if your skin is sore, contact your healthcare provider.
• Keep the cast elevated above your heart if possible during the first 24 to 48 hours (one to two days). Put it on top of a pillow.
• The skin under your cast may itch. This is an uncomfortable sensation, but you have to leave it alone. Never insert anything into your cast to scratch the itch.
• Wiggle your toes or fingers if it’s safe to do so (check with your healthcare provider). This can help prevent swelling.
• Check the edges of the cast to see if they’re rough or sharp. If they are, use tape and gauze or another thin, soft material to prevent the rough or sharp edges from hurting your skin.

What questions should I ask my healthcare provider about compound fractures?

Your healthcare providers will give you instructions when you leave the emergency department. Make sure you have the answers to the following questions before you go:

• How long will I need to be in a cast?
• Do I need physical therapy while I’m in the cast?
• Do I need physical therapy after the cast comes off?
• Should I see any other specialists (like an orthopaedic surgeon or neurologist)?
• Do I need more X-rays?
• When do I need to follow up, and with whom?
• Do I need prescription medications?

When should I go to the emergency department?

You should never hesitate to go see a healthcare provider when there’s an emergency. If you have a cast on, you need to keep an eye out for the following symptoms:

• The cast causes numbness.
• The cast causes weakness.
• The cast causes continuous or worsening pain.
• The cast feels too tight.
• There’s a strong odor from the cast.
• You have a fever.

Go to the emergency room if you experience any of those symptoms.

Is it possible to leave a cast on too long?

Yes, there are consequences if the immobilization lasts too long, including:

• Joint stiffness.
• Shortened muscles.
• Blood clots.

Be sure to clarify the length of immobilization with your healthcare provider. Attend all follow-up appointments when they’re scheduled.

Do I need to go to physical therapy?

Your healthcare provider may want you to go to physical therapy during and/or after immobilization in a cast. Your therapist will help you with stretches and exercises to improve your:

• Strength.
• General functions.
• Range of motion.

How is a cast applied?

Once your bones are lined up correctly, your healthcare provider will wrap the area in cloth and cotton material to protect your skin. Next, they’ll wrap your injury in bandages that are wet with plaster or fiberglass strips. The bandages and strips will harden when they dry.

A note from Cleveland Clinic

An accident that causes a compound fracture is a frightening event. It’s traumatic and the broken bones can be extremely painful. If you have a compound fracture you’ll probably have to go into surgery to align your bones and get a cast. Depending on several factors, it can take weeks to months to heal. This can be a frustrating period in your life. Remember to take care of your cast and get lots of rest to speed up your healing.