The Treatment of Closed Fractures with Soft Tissue Injuries

Abstract

Increasingly, closed fractures with associated soft tissue injuries are presenting the attending physician with difficult decisions in terms of diagnosis and management (Tscherne, Brügge-mann 1976; Weiss et al. 1978). The soft tissue trauma is usually more difficult to evaluate than in open fractures, often causing the surgeon to underestimate the true extent of the damage. A full-thickness skin contusion is a more serious injury than the simple skin perforation characteristic of open fractures. Skin necrosis leading to secondary infection is a typical complication of the closed injury. Even in the absence of full-thickness necrosis, the contusion can disrupt the integrity of the cutaneous barrier, rendering it permeable to bacteria.