What is the first step in managing an open, angulated, and unstable fracture?

In the management of an open, angulated, and unstable fracture, the first critical step is copious lavage and debridement. This procedure is essential for several reasons. Open fractures present a significant risk for infection, as external contaminants and bacteria can easily enter the wound. By performing adequate wound irrigation (lavage), it helps to remove any debris, foreign materials, and bacteria from the fracture site, significantly reducing the risk of infection and promoting a better healing environment.

Debridement, which involves the removal of devitalized tissue and contamination, is also vital. Debridement helps to ensure that only healthy tissue is left at the site of the injury, facilitating effective healing and minimizing the potential for complications, such as osteomyelitis (infection of the bone).

After stabilization through lavage and debridement, further treatment can proceed, such as immobilization, stabilization, or surgical fixation, depending on the assessment of the fracture and the patient's overall condition. It's important to prioritize wound management, as it sets the foundation for successful outcomes in treating open fractures.