For closed fractures, a curved incision of the skin is made starting at the center of the fracture and then extended beyond the length of the fracture.
Once the wound debrided and rinsed and the skin is incised, the skin is retracted and the fracture assessed.
Note: Care must be exercised during preparation of the fracture site to preserve the connection between the periosteum and the underlying bone fragments.
The wound edges are debrided and the wound rinsed liberally. Sinuses that have been exposed by the injury are also rinsed.
Small loose bone fragments that are void of periosteum attachments are removed.
Impression fractures typically have multiple fragments that are displaced inward and firmly wedged together; they are identified and any blood clots are carefully removed.