Management of open hand fractures

Open fractures of the hand are a challenging problem for the hand surgeon because of the global nature of the injury. The soft-tissue envelope and skeletal structure are disrupted and often there is additional injury to the blood supply, nerves, and tendons. Furthermore, contamination of the wound is associated with an increased risk for infection. The surgeon must apply a systematic approach to the treatment of these injuries to minimize the risk for infection and scarring while re-establishing the skeletal architecture. Initially, open hand fractures require irrigation and debridement of contaminated and devitalized tissue. The soft-tissue envelope must be reconstructed before definitive skeletal reconstruction and bone grafting. Injuries to the blood supply, nerves, and tendons must be recognized and treated appropriately.