(Disclaimer: This article is only for popularization purposes, in order to protect the patient’s privacy, the relevant information in the following content has been processed) Abstract: Open fracture refers to the fracture end is connected to the outside world, the cause of injury may be caused by the fracture end of the puncture of the skin, or it may be caused by the violence of direct damage to the skin and soft tissues. The patient in this case had an open comminuted fracture of the lower leg due to a vehicular accident with severe soft tissue damage, so the infection should be controlled first in the treatment, followed by the treatment of the fracture. The patient was given medication to control the infection and surgery to treat the fracture. After surgery, the wound healed, the fracture healed, and walking returned to normal. 【Basic information】 Male, 41 years old 【Disease type】 Open fracture 【Hospital visit】 The First Affiliated Hospital of Harbin Medical University 【Date of visit】 December 2020 【Treatment plan】 Surgical treatment (external fixation bracket fixation, fracture incision and reduction and internal fixation surgery) 【Treatment cycle】 The 1st surgery was completed on the same day of outpatient clinic, and the 2nd surgery was performed in 3 months, and the patient was followed up after 1 year of treatment. The wound healed, the fracture healed, and walking returned to normal. The patient had an open fracture of the lower leg caused by a car accident. According to the patient’s description, he was standing at the rear end of the car when the accident happened, but he was caught between the two cars by the rear-end car. After the injury, the calf became swollen, bloody and deformed, and was brought to the emergency room by 120 ambulance. When he first arrived at the hospital, his calf was immobilized by a splint, and a blood-soaked bandage could be seen. The dressings were removed for an initial examination: there were multiple wounds in the calf, a larger wound about 15 cm long, filled with dirt, and the exposed fracture end could be seen. x-rays showed multiple fractures of the tibiofibula. The patient was finally diagnosed with an open fracture. (X-ray) Second, the treatment process The patient belongs to a serious open fracture, needing surgical treatment, so urgent preoperative preparations, the patient immediately began to fasting, water fasting, negative test sensitivity after the application of cephalosporin antibiotics, such as ceftriaxone sodium for injection, intramuscular tetanus antitoxin, intravenous injection of sodium chloride solution, polyglutinin peptide injection line rehydration therapy, expanding blood volume, and at the same time, prepare the red blood cells and plasma, all ready! After completion of all preparations. Surgical treatment was started in the emergency department, firstly, the foreign objects such as soil and glass in the wound were thoroughly removed, and the local necrotic soft tissues were removed, and an external fixation frame was used to fix the bone across the wound, and plasma was transfused with 400 ml during the operation. after the first surgery, the wound was changed regularly, and the drainage was smooth, and the patient was discharged from the hospital to go home to recuperate after the wound was healed. Three months after discharge, the patient’s blood count, blood sedimentation, C-reactive protein returned to normal, and he was hospitalized again for the second surgery, i.e. fracture cut and reduction internal fixation surgery, to promote the healing of the fracture. Third, treatment effect The patient underwent surgical treatment 5 hours after admission to the hospital. After the 1st surgery, the fracture returned to normal force line with the assistance of external fixation bracket, and the wound of the calf healed in about 16 days after surgery. Three months after discharge, the patient’s blood count, blood sedimentation, and C-reactive protein returned to normal, and he was hospitalized again for the 2nd operation, and the postoperative incision healed smoothly without any manifestation of infection. After 3 months, the incision healed successfully without infection and the fracture healed well. Precautions We are glad that the fracture healed well after surgery, but during the waiting time for the second surgery, the patient needs to use medical alcohol to moisten the external fixation pins regularly, change the gauze regularly, and take good care of the external fixation frame. Although they can only stay in bed during this period, the hip, knee and ankle joints of the lower limbs need to be strengthened to avoid muscle atrophy, and red blood cells, blood sedimentation and C-reactive protein need to be rechecked once a month. After the 2nd surgery, patients should continue to use anti-infective drugs until the wound heals. After discharge from the hospital, they need to pay attention to the wound condition, and if there is local redness, swelling and pain, they need to go to the hospital in time for follow-up. The X-ray should be reviewed 3, 6 and 12 months after the surgery, and the time to go down to the ground should be decided according to the healing of the fracture. During this period, the patient should increase the nutrition and calcium intake, and consume more soybean and milk products, and increase the sunshine at the same time. V. Personal perception Open fracture generally soft tissue damage is heavier than the fracture, so the skin and soft tissue conditions should be considered first. Open fractures are often fixed with an external fixator, which can stabilize the fracture and also facilitate wound healing. However, external fixation is difficult to maintain the stability of the fracture end and is not conducive to fracture healing in the long run. Therefore, after the infection is completely controlled, the fracture needs to be replaced with an incisional reduction and internal fixation surgery as the final treatment of the fracture, thus this patient required two surgeries in the treatment of this case.