Antibiotic prophylaxis for open fractures: Difference between revisions
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= Gustilo Classification = |
== Gustilo Classification == |
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* 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 |
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= Risk of Infection = |
== Risk of Infection == |
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* Type I: 0% |
* Type I: 0% |
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** Type IIIC: 20% |
** Type IIIC: 20% |
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= Management = |
== Management == |
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* 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 |
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= Further Reading = |
== Further Reading == |
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* 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. |
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Revision as of 15:02, 17 August 2019
Gustilo Classification
- Type I: open fracture with skin wound <1cm in length and clean
- Type II: open fracture with a laceration >1cm in length without extensive soft tissue damage, flaps, or avulsions
- Type III: open segmental fracture with >10cm wound with extensive soft tissue injury or a traumatic amputation
- IIIA: adequate soft tissue coverage
- All farm injuries and gunshots are automatically at least IIIA
- 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:
- gunshot injuries
- any open fracture caused by a farm injury
- any open fracture with accompanying vascular injury requiring repair
- IIIA: adequate soft tissue coverage
Risk of Infection
- Type I: 0%
- Type II: 2%
- Type III: 6-44%
- Type IIIA: 2%
- Type IIIB: 11%
- Type IIIC: 20%
Management
- Don't forget tetanus!
- Antibiotic choice
- Cover gram-negatives as soon as possible after injury
- Add gram-negative coverage for type III fractures
- At HGH: cefazolin, tobramycin, and metronidazole
- 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
- Duration
- Continue for 24 hours after wound closure
- If type III, continue for at least 72 hours post-injury if Type III
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.
