Ursone listed a number of indications for when to debride a wound containing explosive fragments. The authors if from the San Antonio Orthopaedic Group in San Antonio, Texas.


Patient selection: explosive injury with fragments



wound > 1 cm in diameter

greater risk for necrotic tissue damage and infection

intra-articular fragments

risk for mechanical arthritis, synovitis and lead poisoning

intra-osseous fragments associated with fracture

reduce risk of fracture non-union or to improve fracture fixation

fragments adjacent to a blood vessel

risk of erosion into blood vessel with embolization


An additional indication (not listed by the author) may be an infection unresponsive to conservative management, especially if tissue necrosis or the nature of the fragments is contributing to the infection.


A small wound with small fragments can be managed conservatively with antibiotics. With time the fragment may migrate to the skin surface (“work its way out”) at which time it can be locally excised.


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