Open Fractures Antibiotics

Author: Anay Patel Topic updated on 05/30/13 8:39am

Introduction

Definition a fracture with direct communication to a break in the skin

Basic Principles of Open Fracture Management in the Emergency Room Fracture management begins after initial trauma survey and resuscitation is complete Antiobiotics o initiate early IV antibiotics and update tetanus prophylaxis Control bleeding o direct pressure will control active bleeding o do not blindly clamp or place tourniquets on damaged extremities Assessment o assess soft-tissue damage Dressing o place sterile saline-soaked dressing on the wound Stabilize o splint fracture for temporary stabilization Basic Principles of Open Fracture Management in the Operating Room Aggressive debridement and irrigation o low pressure lavage more effective in reducing bacterial counts than high pressure lavage o saline shown to be most effective irrigating agent o remove boney fragments without soft tissue attachment Fracture stabilization Staged debridement and irrigation o perform every 24 to 48 hours as warranted Early soft tissue coverage or wound closure Can place antibiotic bead-pouch in open dirty wounds o beads made by mixing methylmethacrylate with aminoglycocide powder and/or vancomycin powder

IV Antibiotic Treatment Gustillo Grade I and II o 1st generation cephalosporin Gustillo Grade III o 1st generation cephalsporin and aminoglycoside Farm injuries or possible bowel contamination o add penicillin for anaerobic coverage (clostridium) Duration o initiate as soon as possible studies show increased infection rate when antibiotics are delayed for more than 3 hours from time of injury o continue for 24-72 hours after initial injury o continue for 24 hours after any debridement procedures until wound is closed Tetanus Prophylaxis

Initiate in emergency room Two forms of prophylaxis o toxoid dose if 0.5 mL regardless of age o immune globulin dosing <5-years-old receives 75U 5-10-years-old receives 125U >10-years-old receives 250U o should given intramuscularly with two different syringes in two different locations Guidelines for tetanus prophylaxis depend on 3 factors o complete or incomplete vaccination history (3 doses) o date of most recent vaccination o severity of wound