The objective of this chapter is to introduce the open fractures. Open fractures (the term compound fractures being no longer preferred) are those in which a bone or joint structure is exposed to the environment due to disruption of the soft tissues and overlying skin. These are usually high-energy injuries with severe bone and soft tissue involvement and are often associated with decreased vascular supply, contamination, degloving of skin and a variable degree of soft tissue damage. Improvements in intensive care management, the availability of powerful antibiotics and development of surgical principles of radical debridement, immediate bone stabilization, and early soft tissue cover have largely improved the outcome. This chapter also covers the history of management of open injuries, initial evaluation and management, pathophysiology of open fractures, mangled extremity severity score (MESS), microbiology, infection in open injuries, role of antibiotics in open surgeries, skeletal stabilization, external fixation, interlocking nails, plate stabilization, skin and soft tissue reconstruction, and negative pressure wound therapy in brief.