Antibiotic prophylaxis for open fractures

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

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