Which finding indicates an open fracture?

• A. Swelling with no external wound
• B. Pain with movement only
• C. Crepitus with no deformity
• D. Bone protruding from the wound

Answer: (D)

Open fractures are defined by a skin break that communicates with the fracture site, meaning the bone is exposed or protruding through the wound. The finding of bone protruding from the wound is the clearest indicator because it shows a breach in both skin and soft tissues with direct exposure of the fracture to the outside environment. This carries a high infection risk and changes management: cover the wound with a sterile dressing, avoid probing or pushing the bone back in, immobilize the limb, and transport promptly for definitive care with infection prophylaxis as indicated.

Swelling with no external wound suggests a closed fracture; pain with movement is common to many injuries and isn’t specific to an open fracture; crepitus with no deformity can occur in both open and closed fractures and doesn’t demonstrate skin breach. The presence of bone protruding through the skin uniquely identifies an open fracture.