Antibiotic prophylaxis for open fractures - Revision history

Aidan: Text replacement - " species]]" to "]]"

2022-02-08T02:52:36Z

Text replacement - " species]]" to "]]"

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	** Consider adding anaerobic coverage		** Consider adding anaerobic coverage
	** For example, one Ontario trauma center uses '''[[Is treated by::cefazolin]], [[Is treated by::tobramycin]], and [[Is treated by::metronidazole]]'''		** For example, one Ontario trauma center uses '''[[Is treated by::cefazolin]], [[Is treated by::tobramycin]], and [[Is treated by::metronidazole]]'''
	** Add high-dose penicillin to cover [[Clostridium ~~species~~]], in the presence of fecal contamination or farm-related injuries		** Add high-dose penicillin to cover [[Clostridium]], in the presence of fecal contamination or farm-related injuries
	** [[Fluoroquinolones]] should be avoided, if possible, due to slowing bone healing		** [[Fluoroquinolones]] should be avoided, if possible, due to slowing bone healing
	* '''Duration'''		* '''Duration'''

Aidan: /* Further Reading */ added URL

2019-11-15T15:59:03Z

Aidan: formatting

2019-11-15T15:57:59Z

formatting

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	== Gustilo Classification ==		== Gustilo Classification ==
			* '''Type I''': open fracture with skin '''wound <1cm''' in length and clean

	* Type I: open fracture with ~~skin~~ wound <1cm in length ~~and~~ ~~clean~~		* '''Type II''': open fracture with a '''wound >1cm''' in length without extensive soft tissue damage, flaps, or avulsions
	* Type II: open fracture with a ~~laceration~~ >~~1cm~~ in length ~~without~~ extensive soft tissue ~~damage, flaps,~~ or ~~avulsions~~		* '''Type III''': open segmental fracture with a '''wound >10cm''' in length with '''extensive soft tissue injury''' or a traumatic amputation
		⚫	** '''IIIA''': adequate soft tissue coverage
	* Type III: open segmental fracture with >10cm wound with extensive soft tissue injury or a traumatic amputation
		⚫	*** All '''farm injuries and gunshots''' are automatically at least IIIA
⚫	** IIIA: adequate soft tissue coverage
		⚫	** '''IIIB''': significant soft tissue loss with '''exposed bone''' that requires soft tissue transfer to achieve coverage
⚫	*** All farm injuries and gunshots are automatically at least IIIA
		⚫	** '''IIIC''': associated '''vascular injury''' that requires repair for limb preservation
⚫	** IIIB: significant soft tissue loss with exposed bone that requires soft tissue transfer to achieve coverage
⚫	** IIIC: associated vascular injury that requires repair for limb preservation
	** Special categories:		** Special categories:
	*** gunshot injuries		*** '''gunshot injuries'''
	*** any open fracture caused by a farm injury		*** any open fracture caused by a '''farm injury'''
	*** any open fracture with accompanying vascular injury requiring repair		*** any open fracture with accompanying '''vascular injury requiring repair'''

	== Risk of Infection ==		== Risk of Infection ==

	* Type I: 0%		* Type I: 0%
	* Type II: 2%		* Type II: 2%
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	== Management ==		== Management ==
		⚫	* Don't forget '''tetanus'''!

		⚫	* '''Antibiotic choice'''
⚫	* Don't forget tetanus!
		⚫	** Cover Gram-positives as soon as possible after injury, e.g. with cefazolin
⚫	* Antibiotic choice
			** Add Gram-negative coverage for type III fractures, e.g. with tobramycin
⚫	** Cover ~~gram~~-positives as soon as possible after injury
	** ~~Add~~ ~~gram-negative~~ coverage ~~for type III fractures~~		** Consider adding anaerobic coverage
	** At ~~HGH:~~ cefazolin, tobramycin, and metronidazole		** For example, one Ontario trauma center uses '''[[Is treated by::cefazolin]], [[Is treated by::tobramycin]], and [[Is treated by::metronidazole]]'''
	** Add high-dose penicillin to cover ~~clostridium~~, in the presence of fecal contamination or farm-related injuries		** Add high-dose penicillin to cover [[Clostridium species]], in the presence of fecal contamination or farm-related injuries
	** Fluoroquinolones should be avoided, if possible, due to slowing bone healing		** [[Fluoroquinolones]] should be avoided, if possible, due to slowing bone healing
	* Duration		* '''Duration'''
	** Continue for 24 hours after wound closure		** Continue for 24 hours after wound closure
	** If type III, continue for at least 72 hours post-injury if Type III		** If type III, continue for at least 72 hours post-injury if Type III

	== Further Reading ==		== Further Reading ==

	* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.		* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.

Aidan: /* Management */

2019-11-15T15:14:19Z

Management

← Older revision		Revision as of 15:14, 15 November 2019
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	* Don't forget tetanus!		* Don't forget tetanus!
	* Antibiotic choice		* Antibiotic choice
	** Cover gram-~~posatives~~ as soon as possible after injury		** Cover gram-positives as soon as possible after injury
	** Add gram-negative coverage for type III fractures		** Add gram-negative coverage for type III fractures
	** At HGH: cefazolin, tobramycin, and metronidazole		** At HGH: cefazolin, tobramycin, and metronidazole

Aidan: /* Management */

2019-11-15T15:14:07Z

Management

← Older revision		Revision as of 15:14, 15 November 2019
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	* Don't forget tetanus!		* Don't forget tetanus!
	* Antibiotic choice		* Antibiotic choice
	** Cover gram-~~negatives~~ as soon as possible after injury		** Cover gram-posatives as soon as possible after injury
	** Add gram-negative coverage for type III fractures		** Add gram-negative coverage for type III fractures
	** At HGH: cefazolin, tobramycin, and metronidazole		** At HGH: cefazolin, tobramycin, and metronidazole

Aidan at 15:02, 17 August 2019

2019-08-17T15:02:24Z

← Older revision		Revision as of 15:02, 17 August 2019
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	= Gustilo Classification =		== Gustilo Classification ==

	* Type I: open fracture with skin wound <1cm in length and clean		* Type I: open fracture with skin wound <1cm in length and clean
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	*** any open fracture with accompanying vascular injury requiring repair		*** any open fracture with accompanying vascular injury requiring repair

	= Risk of Infection =		== Risk of Infection ==

	* Type I: 0%		* Type I: 0%
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	** Type IIIC: 20%		** Type IIIC: 20%

	= Management =		== Management ==

	* Don't forget tetanus!		* Don't forget tetanus!
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	** If type III, continue for at least 72 hours post-injury if Type III		** If type III, continue for at least 72 hours post-injury if Type III

	= Further Reading =		== Further Reading ==

	* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.		* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.

Aidan at 01:42, 15 August 2019

2019-08-15T01:42:44Z

← Older revision		Revision as of 01:42, 15 August 2019
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	** Continue for 24 hours after wound closure		** Continue for 24 hours after wound closure
	** If type III, continue for at least 72 hours post-injury if Type III		** If type III, continue for at least 72 hours post-injury if Type III

⚫	[[Category:Trauma and surgical ~~infections~~]]

	= Further Reading =		= Further Reading =

	* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.		* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.

		⚫	[[Category:Trauma and surgical patients]]

Aidan: Added Further Reading section

2019-08-13T11:06:04Z

Added Further Reading section

← Older revision		Revision as of 11:06, 13 August 2019
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	[[Category:Trauma and surgical infections]]		[[Category:Trauma and surgical infections]]

			= Further Reading =

			* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.

Aidan: /* Risk of Infection */ added percentage risk estimates

2019-08-13T11:03:43Z

Risk of Infection: added percentage risk estimates

← Older revision		Revision as of 11:03, 13 August 2019
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	= Risk of Infection =		= Risk of Infection =

	* Type I		* Type I: 0%
	* Type II		* Type II: 2%
	* Type III		* Type III: 6-44%
			** Type IIIA: 2%
			** Type IIIB: 11%
			** Type IIIC: 20%

	= Management =		= Management =

Aidan at 10:56, 13 August 2019

2019-08-13T10:56:25Z

← Older revision		Revision as of 10:56, 13 August 2019
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		⚫	= Gustilo Classification =
	= Antibiotic prophylaxis for open fractures =

⚫	== Gustilo Classification ==

	* Type I: open fracture with skin wound <1cm in length and clean		* Type I: open fracture with skin wound <1cm in length and clean
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	*** any open fracture with accompanying vascular injury requiring repair		*** any open fracture with accompanying vascular injury requiring repair

	== Risk of Infection ==		= Risk of Infection =

	* Type I		* Type I
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	* Type III		* Type III

	== Management ==		= Management =

	* Don't forget tetanus!		* Don't forget tetanus!
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	** Continue for 24 hours after wound closure		** Continue for 24 hours after wound closure
	** If type III, continue for at least 72 hours post-injury if Type III		** If type III, continue for at least 72 hours post-injury if Type III

			[[Category:Trauma and surgical infections]]

← Older revision		Revision as of 15:59, 15 November 2019
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	== Further Reading ==		== Further Reading ==
	* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8.		* Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. ''J Bone Joint Surg Am''. 1976 Jun;58(4):453-8. pmid: [https://www.ncbi.nlm.nih.gov/pubmed/773941 773941]

	[[Category:Trauma and surgical patients]]		[[Category:Trauma and surgical patients]]