Open Fracture Wound Management / Tetanus

Last Updated on by FRCEM Intermediate

Wound Management 

  • Control hemorrhage if bleeding e.g. direct pressure
  • Give Adequate Analgesia
  • Wound assessment – Examine the wound, surrounding tissue, for any foreign body, contamination, and damage to the underlying structure
  • Assess neurovascular status
  • Reduce gross deformities using gentle traction and splint the injured limb especially  if there is a neurovascular compromise
  • Remove gross contaminants from the wound – clean by profusely irrigating with saline and cover the wound with a sterile dressing
    Apply Dressing
  • Immobilize the limb and Elevate
  • Give tetanus toxoid/ tetanus immunoglobulin if indicated
  • Prophylactic antibiotics
  • X-ray to Rule out fracture/Foreign body
  • Refer to Orthopedics and or plastic surgery

Immediate management of any fracture (the order may vary, and not every step is required in every instance):

Control hemorrhage and correct coagulopathy
Seek and treat Complications
Clean and cover any open wounds
AAA therapy (analgesia, antibiotics, ADT/ tetanus)
Reduce and immobilise

Tetanus Prone Wounds

  • wounds or burns delayed more than 6 hours that need surgical intervention
  • wounds or burns with a significant degree of devitalized tissue
  • puncture-type injury
  • wounds containing foreign bodies
  • compound fractures

Five vaccines (N.B. A total of five doses of tetanus vaccine, administered at the appropriate intervals, is considered to give lifelong immunity)

  • First three doses are given at 2, 3 and 4 months
  • The first booster is given at 3 years and 4 months (preschool)
  • The second booster is given at 14 years of age








High-risk tetanus-prone wounds are those with heavy contamination with material likely to contain tetanus spores (i.e. soil, manure) and/or extensive devitalized tissue.

The dose of human tetanus immunoglobulin is normally 250 IU by intramuscular injection, or 500 IU if more than 24 hours have elapsed.

Tetanus vaccine should be injected at a different site from immunoglobulin so that it is not ‘neutralised’ by the passive immunization

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