What is the initial management principle for an open fracture?

• A. Immobilize and observe
• B. Oral antibiotics only
• C. Immediate IV antibiotics and urgent surgical debridement; stabilization as needed
• D. Immediate joint replacement

Answer: (C)

Open fractures carry a high risk of infection because the wound communicates with the outside environment. The priority is to prevent infection by rapid broad-spectrum IV antibiotics and urgent surgical debridement to remove devitalized tissue and contamination. Stabilization of the fracture is then done as needed after thorough debridement and wound assessment. Options like immobilizing alone, oral antibiotics only, or rushing to joint replacement do not adequately address the contaminated wound and tissue viability, and are not appropriate as initial management. Early antibiotics and prompt surgical debridement dramatically reduce infection risk and improve outcomes, with fixation after the wound is cleaned.