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 o...
 PMHx:
    Hypertension
    Hyperlipidemia

 PSHx:
    Lt THR (3 years)
    Lt Fibula # with plate and I.M nailing. ...
 Physical Exam:
    V/S : 36.8 - 120/76 - 67 – 17
    HEENT: Broses on the chin
    Chest: CTA bil.
    CVS: S1 + S2 ...
 Dose the patient need Abx prophylaxis?
 If yes, what Abx should be used & for how long?
 What else should be considere...
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 ...
antibiotics “Gram Positive coverage” should be started as soon as
                  possible after injury and continued fo...
antibiotics “Gram Positive coverage” should be started as soon as
              possible after injury and continued for 5 ...
Tetanus vaccination history .
Open Fracture Antibiotics prophylaxis
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Open Fracture Antibiotics prophylaxis

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Antibiotics prophylaxis for different types of bone fractures pre-op

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Open Fracture Antibiotics prophylaxis

  1. 1. Dr. Richard Chmielewski Dr. Abdul Hamid Alraiyes
  2. 2.  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.
  3. 3.  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
  4. 4.  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
  5. 5.  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?
  6. 6. The Abx prophylaxis depends on the type of the open fracture
  7. 7. • Wound less than 1 cm, • without contamination • minimal injury of soft tissue.
  8. 8. • Wound between 1 -10 cm • mild contamination • extensive soft tissue damage and moderate crushing component.
  9. 9. • Wound larger than 10 cm • severe contamination • severe crushing component.
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. Tetanus vaccination history .

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