A traumatic accident like a fall or car crash can break your leg or other bones in your body. If a broken bone pierces your skin, it’s called a compound fracture. You’ll need surgery to realign your bones and then a cast to keep them immobilized. Always go to the emergency department if you think you have a broken bone.
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.
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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:
Severe trauma causes compound fractures. Examples of events that can cause this type of severe trauma include a:
A broken bone is a compound fracture if it breaks through your skin. You can see the broken bone. Additional symptoms include:
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:
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.
When you get to the emergency department you’ll get one or more pain relief options, including:
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.:
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:
Your bones will then be immobilized in a cast or other device.
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 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.
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.
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:
More severe complications include:
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:
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.
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:
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.
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:
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:
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:
Go to the emergency room if you experience any of those symptoms.
Yes, there are consequences if the immobilization lasts too long, including:
Be sure to clarify the length of immobilization with your healthcare provider. Attend all follow-up appointments when they’re scheduled.
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:
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.
Last reviewed by a Cleveland Clinic medical professional on 09/29/2021.
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