Abstract
Open fractures are complex injuries that significantly increase the risk of infection and complications such as delayed healing, nonunion, and chronic osteomyelitis. Infections rates remain high, particularly in severe cases involving extensive soft tissue damage and contamination. This is due to a variety of factors involving the patient, environment and bacteria. This article critically reviewed the classification, common pathogens, and complications associated with open fractures, emphasizing the challenges posed by biofilms, antibiotic resistance, and host factors such as diabetes and immunosuppression. Current management strategies, including early antibiotic administration, surgical debridement, and wound care, are examined alongside emerging therapies such as continuous local antibiotic perfusion, antibiotic-coated implants, bacteriophage therapy, and bioelectric dressings. These approaches show promise in reducing infection rates, enhancing patient outcomes, and addressing the limitations of traditional treatments. However, there are gaps in understanding their long-term efficacy, especially in high-risk populations. Future research should focus on personalized protocols, combination therapies, and clinical trials to reduce the burden of infection-related complications in open fracture management.