An open fracture is an injury where the fractured bone and/or fracture hematoma are exposed to the external environment via a traumatic violation of the soft tissue and skin. The skin wound may lie at a site distant to the fracture and not directly over it. Most severe open fractures are first stabilized with external fixation. In this operation, the doctor inserts metal screws or pins into the bone above and below the fracture site. The pins and screws project out of the skin where they are attached to metal or carbon fiber bars.