Dr. Richard Chmielewski
Dr. Abdul Hamid Alraiyes

 80 years old CF
 Chief Complain
 Fall
 Pain on the Lt elbow
 Transferred from another ER with a diagnosis of:
 Fracture of the Lt proximal ulna
 Open fracture type I.
 ID consult : POD # 1
 For ABx prophylaxis because of the open fracture type I.

 PMHx:
 Hypertension
 Hyperlipidemia
 PSHx:
 Lt THR (3 years)
 Lt Fibula # with plate and I.M nailing. (8 years )
 NKDA
 No blood transfusion
 Meds:
 Tenormine 50 mg PO QD
 Social Hx:
 No Hx Of smoking / ETOH/ elicit drugs

 Physical Exam:
 V/S : 36.8 - 120/76 - 67 – 17
 HEENT: Broses on the chin
 Chest: CTA bil.
 CVS: S1 + S2 + PSM III/VI
 ABD: soft, Lax and no tenderness
 EXT: no edema , good pulse , Lt upper arm dressed with a cast.
 Labs:
 WBC = 10.4 , Hb= 12.4, Ht= 37, Plt= 241
 Na= 140, K= 4, Cl= 104, CO2= 28, BUN= 15, Cr= 0.5, Glu= 110

 Dose the patient need Abx prophylaxis?
 If yes, what Abx should be used & for how long?
 What else should be considered apart from Abx prophylaxis?

The Abx prophylaxis depends on the type of the open fracture

• Wound less than 1 cm,
• without contamination
• minimal injury of soft
tissue.

• Wound between 1 -10 cm
• mild contamination
• extensive soft tissue damage and
moderate crushing component.

• Wound larger than 10 cm
• severe contamination
• severe crushing component.

antibiotics “Gram Positive coverage” should be started as soon as possible
after injury and continued for 3 days*
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100

antibiotics “Gram Positive coverage” should be started as soon as
possible after injury and continued for 3 days*
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100

antibiotics “Gram Positive coverage” should be started as soon as
possible after injury and continued for 5 days*
combined with local therapy consisting of antibiotic-impregnated
polymethylmethacrylate beads
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100

Tetanus vaccination history .