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J Am Acad Orthop Surg, Vol 11, No 6, November/December 2003, 431-438.
© 2003 the American Academy of Orthopaedic Surgeons
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Soft-Tissue Injury Associated With Closed Fractures: Evaluation and Management

Frank Tull, MD and Joseph Borrelli, Jr, MD

Dr. Tull is Fellow, Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO. Dr. Borrelli is Assistant Professor, Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital.

Reprint requests: Dr. Borrelli, Barnes-Jewish Hospital, Suite 11300, West Pavilion, One Barnes-Jewish Hospital Plaza, St. Louis, MO 63110.

Determination of the severity of injury to the soft tissues is an important component of patient assessment and affects management of closed fractures. The response of soft tissue to blunt injury involves microvascular and inflammatory processes that produce localized tissue hypoxia and acidosis. Incisions placed through such compromised tissue can lead to wound breakdown and deep infection. Therefore, recognizing the signs of soft-tissue injury is the foundation for successful management of closed fractures. Many treatment options, including splinting, cryotherapy, compression, and delayed surgery, help limit further soft-tissue injury and facilitate its rapid recovery before surgical intervention. Emerging surgical techniques based on improved management have resulted in decreased rates of soft-tissue complications.






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