Open Fracture Antibiotics prophylaxis

Slide 1: Dr. Richard Chmielewski Dr. Abdul Hamid Alraiyes

Slide 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.

Slide 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

Slide 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

Slide 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?

Slide 6: The Abx prophylaxis depends on the type of the open fracture

Slide 7: • Wound less than 1 cm, • without contamination • minimal injury of soft tissue.

Slide 8: • Wound between 1 -10 cm • mild contamination • extensive soft tissue damage and moderate crushing component.

Slide 9: • Wound larger than 10 cm • severe contamination • severe crushing component.

Slide 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

Slide 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

Slide 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

Slide 13: Tetanus vaccination history .