Antibiotic prophylaxis for open fractures: Difference between revisions
From IDWiki
m (Aidan moved page Special Trauma and Antibiotic prophylaxis for open fractures to Antibiotic prophylaxis for open fractures without leaving a redirect) |
No edit summary |
||
| Line 1: | Line 1: | ||
| ⚫ | |||
= Antibiotic prophylaxis for open fractures = |
|||
| ⚫ | |||
* Type I: open fracture with skin wound <1cm in length and clean |
* Type I: open fracture with skin wound <1cm in length and clean |
||
| Line 15: | Line 13: | ||
*** any open fracture with accompanying vascular injury requiring repair |
*** any open fracture with accompanying vascular injury requiring repair |
||
= Risk of Infection = |
|||
* Type I |
* Type I |
||
| Line 21: | Line 19: | ||
* Type III |
* Type III |
||
= Management = |
|||
* Don't forget tetanus! |
* Don't forget tetanus! |
||
| Line 33: | Line 31: | ||
** 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]] |
|||
Revision as of 10:56, 13 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
- Type II
- Type III
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
