The management of fractures in thermally injured patients.

The occurrence of fractures in association with burn wounds has been considered a formidable combination which compromises the care of both types of injuries. During a 5-year period, 42 fractures were treated in 22 patients admitted to the burn center. A variety of fracture management techniques were used on an individualized basis. When fracture stabilization was necessary, external fixation provided acceptable fracture care while permitting access to the burn wound for dressings, grafting, and physical therapy. The presence of an overlying burn wound has been considered an absolute contraindication to the performance of internal fixation of fractures. However, we have found that this procedure can be performed safely provided that consideration is given to a number of factors, including timing of the operation, the importance of intraoperative fluid resuscitation, and the appropriate indications for this method of treatment.