Patients were randomized to an antibiotic regimen of ciprofloxacin or ceftazadime/gentamicin. Antibiotics are an important adjunct to the management of open fractures and should be initiated as soon as possible. 10/17/2019
open fractures are fractures with direct communication to the external environment treatment requires immediate IV antibiotics and urgent irrigation and debridementthe presence of an open wound does not preclude the occurrence of compartment syndrome in the injured limbin the absence of life-threatening injuries, there is no clinical advantage to performing surgery within 6 hours of injury versus 6-24 hourscontamination with dirt and debris and devitalization of the soft tissues increase the risk of infection and other complicationsobtain information regarding mechanism, location, and timing of injurythe size and nature of the external wound may not reflect the damage to the deeper structuresif concern for vascular insult, ankle brachial index (ABI) should be obtainedvascular surgery consult and angiogram is warranted if ABI < 0.9 consider saline load test or CT scan if concern for traumatic arthrotomy some studies now show CT scan more sensitive than saline load test for the kneeobtain radiographs including joint above and below fracturea soft tissue wound in proximity to a fracture should be treated as an open fracture until proven otherwisemutlidisciplinary training of open fracture management has been associated with decreased timing to antibiotic administration antibiotic type indicated by injury pattern and locationconsider I&D as soon as possible, may be beneficial within 6 hours in terms of decreasing infection riskideal time of soft tissue coverage controversial, but most centers perform within 5-7 daysinfection rates of open fracture depend on zone of injury, periosteal stripping and delay in treatmentincidence of fracture related infection range from <1% in grade I open fractures to 30% in grade III fracturesonce soft tissue coverage is obtained and an adequate sterility is achieveddefinitive treatment with internal fixation leads to significantly decreased time to union, improved functional outcomes, and decreased time in the hospital compared to those definitively fixed with external fixation Urgent IV antibiotics, tetanus prophylaxis, extremity stabilization and dressingsstudies show increased infection rate when antibiotics are delayed for more than continue for 24 hours after initial injury if wound is able to be closed primarilycontinue for 24 hours after final closure if wound is not closed during initial surgical debridement (48 hours for type III wounds)clindamycin or vancomycin can also be used if allergies existfarm injuries, heavy contamination, or possible bowel contamination fluoroquinolones or 3rd or 4th generation cephalosporintoxoid and immunoglobulin should be given intramuscularly with two different syringes in two different locationsguidelines for tetanus prophylaxis depend on 3 factors complete or incomplete vaccination history (3 doses)splint, brace, or traction for temporary stabilization decreases pain, minimizes soft tissue trauma, and prevents disruption of clotsremove gross debris from wound, do not remove any bone fragmentslittle evidence to support aggressive irrigation or irrigation with antiseptic solution in the ED, as this can push debris further into wound data is conflicting but most centers performed irrigation extend wound proximally and distally in line with extremity to adequate expose open fracturelow-pressure bulb irrigation vs. high-pressure pulse lavage studies have shown that low pressure bulb irrigation is less expensive than high pressure pulse lavage and has no difference in infection rates or union rates saline vs. saline with castile soap vs. antibiotic solution studies have shown that saline with castile soap had decreased primary wound healing problems when compared to antibiotic solutionson average, 3L of saline are used for each successive Gustilo type (i.e 9L for type III)thorough debridement of devitalized tissue is critical to prevent deep infectionbony fragments without soft tissue attachments should be removedexternal fixation is temporary initial treatment of choice for majority of high energy open fractures of the lower extremity.
initial treatment for all open fractures. 3875
(OBQ14.128)
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- Open Fractures Management
Open Tibia Fracture in 29F
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), Hospital of St. Raphael, New Haven, Connecticut; Divison of Trauma (R.C.
Keywords: open fracture, penicillin, antibiotics, infection Definition: An open fracture is one in which disruption of the skin and underlying soft tissues results in exposure of the wound to the outside environment.
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- Open Fractures Management
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© 2020 Eastern Association for the Surgery of Trauma. L1\L2 Evidence
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), University of Cincinnati, Cincinnati, Ohio.Presented at the 21st Annual Assembly of the Eastern Association for the Surgery of Trauma, January 19, 2008, Jacksonville, Florida.An open fracture is defined as one in which the fracture fragments communicate with the environment through a break in the skin. Upgrade to PEAK
Gram-positive coverage is recommended for type I and type II fractures.
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