An open fracture is MOST accurately defined as a fracture in which:

• A. A large laceration overlies the fracture.
• B. Bone ends protrude through the skin.
• C. The overlying skin is no longer intact.
• D. A bullet shatters the underlying bone.

Answer: (C)

Open fractures occur when the skin over the fracture is breached, allowing the fracture to communicate with the outside environment. The defining feature is that the overlying skin is no longer intact, which is exactly what this statement expresses. While bone ends protruding through the skin is a dramatic and common sign, it is not required—the skin can be broken with the fracture still communicating with the exterior without visible bone protrusion. This skin breach changes management because it raises infection risk and calls for prompt wound care, coverage, antibiotics, and careful handling.