Open fracture consequences - will this need amputation?

StarryEyes · Dec 23, 2014

My MC broke his arm after being pushed out of a tree (approximately equivalent height to falling out a window two floors up from the ground). The fracture is located in the forearm, just below the elbow, and the bone pierces the skin, but just barely (not like those awful pictures of open wound fractures with half the skin missing, added to my list of "google searches I'd rather forget").

MC is a healthy and very fit 25-year-old male. The accident occurs in a jungle in a fantasy world with no access to modern medicine. His friends improvise an operation to put the bone back in place and give MC a sling, a bandage and lots of painkilling and antibacterial plants, but that's all they can do for at least another two weeks, until they reach the closest village.

So my question: how likely, given the conditions, would the wound develop gangrene and need amputation? From what I've read it seems pretty likely, but I just thought I'd check. I'm okay with him losing an arm - either way, even if he keeps it, the injury is intended for him to never be able to use it as before. Of course, since there are made-up plant medicines involved, I can always use them to influence the outcome. But I'd still like to know the risks associated with a (mostly) untreated open fracture - especially since most of the information out there works from the assumption that you can get the victim to a hospital and that modern medicine is available.

Also, any other information about open fractures (pain level, healing time...), especially personal experiences, is welcome

Thanks in advance!

mirandashell · Dec 23, 2014

Are they not able to close the wound?

lbender · Dec 23, 2014

Risk of infection is high, especially in a jungle environment, where there are likely to be bacteria everywhere.

A lot will depend on how clean his arm was when the bone broke, and how clean after - did his arm break on a log covered with mud, for example?

You have lots of options.

King Neptune · Dec 23, 2014

There are plants that would prevent infection, so your can have such plants applied to the wound, or they can leave it dirty and require an amputation; whichever you prefer.

cmhbob · Dec 23, 2014

Even in the modern world of 1865, such an injury would likely result in amputation. I'd easily believe such was the case in a medieval-ish fantasy world. Any magic?

MDSchafer · Dec 23, 2014

StarryEyes said:
So my question: how likely, given the conditions, would the wound develop gangrene and need amputation? From what I've read it seems pretty likely, but I just thought I'd check. I'm okay with him losing an arm - either way, even if he keeps it, the injury is intended for him to never be able to use it as before.

Well the good news your guy wouldn't have to worry about losing an arm. The bad news is that sepsis would probably kill him first.

Michael Davis · Dec 23, 2014

Sepsis is the culprit to blood poison. If you're talking hours to treatment, it can be survivable without loss of limb. If days before treatment, sepsis is likely and the in hospital treatment is rough including 24/7 antibiotic IV treatments of multiple types of ABs. Here's a tidbit for severity once the infection sets in: about 30% of victims with sepsis in hospitals are fatal. Yeah, shocked the hell out of me. It's why I carry a cleaning and first aid kit everywhere I and my family go. Doesn't need to be sepsis. Remember the young lady that got an abrasion on her shoulder water wafting, contracted MRSA and lost her arms. Cuts and wounds, no matter how minor, deserve more caution then they get.

midazolam · Dec 23, 2014

Michael Davis said:
Sepsis is the culprit to blood poison. If you're talking hours to treatment, it can be survivable without loss of limb. If days before treatment, sepsis is likely and the in hospital treatment is rough including 24/7 antibiotic IV treatments of multiple types of ABs. Here's a tidbit for severity once the infection sets in: about 30% of victims with sepsis in hospitals are fatal. Yeah, shocked the hell out of me. It's why I carry a cleaning and first aid kit everywhere I and my family go. Doesn't need to be sepsis. Remember the young lady that got an abrasion on her shoulder water wafting, contracted MRSA and lost her arms. Cuts and wounds, no matter how minor, deserve more caution then they get.

I'm not sure I agree with all this. First off, the mortality rates of sepsis depend on the severity, ie sepsis versus severe sepsis versus septic shock. Also, the vast majority of people who develop sepsis have some kind of underlying disease or injury or whatever that predisposes them to a blood infection (an open fracture could certainly do it). It's very rare that a young, healthy adult will develop sepsis from a minor wound or illness. It happens, sure, but so do lightning strikes and plane crashes. I wouldn't make changes to my daily life based on a fear of sepsis.

That said, sepsis is serious and potentially life-threatening. Also, when people with sepsis lose their hands or feet, it's often due to vasoconstriction (narrowing of vessels) from the pressors (drugs being used to maintain blood pressure) rather than the infection itself.

Open fracture consequences - will this need amputation?

Did...did I do that?