Debridement and Management of Open Fractures in Combat Trauma

Open fractures after high-energy and combat trauma demand far more than simply treating a broken bone. This lecture approaches them as complex injuries involving bone, soft tissues, contamination, infection risk, and the future function of the limb.

Drawing on extensive wartime clinical experience at Ternopil Regional Hospital, the speaker reviews the classification and treatment goals of open fractures before moving to the central topic: how to perform a systematic, high-quality wound debridement. The discussion follows the wound layer by layer—from skin and subcutaneous tissue to fascia, muscle, tendons, and bone—with practical criteria for deciding what can remain and what must be removed.

Particular attention is given to muscle viability, free bone fragments, clinically significant foreign bodies, irrigation, compartment syndrome, repeat debridement, external fixation, VAC therapy, local antibiotic delivery, and the timing of definitive soft-tissue coverage. The lecture also explains the “big five” steps used to organize treatment toward three linked goals: preventing infection, achieving fracture union, and restoring useful limb function.

The principles are illustrated through challenging real cases of blast injuries, contaminated wounds, bone and soft-tissue defects, exposed neurovascular structures, and limb reconstruction. The case discussions show why apparently small wounds may conceal extensive damage—and why the quality of the first debridement can shape everything that follows.

The closing Q&A adds practical discussion on civilian versus combat open fractures, antibiotic-loaded cement spacers, preservation versus amputation in severe foot injuries, protection of neurovascular structures during debridement, and early orthoplastic reconstruction.