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Open Fracture Prophylaxis - #PHARMFAX

Updated: Aug 28, 2023

Open fractures can lead to several complications, including compartment syndrome and osteomyelitis.

 


Open fractures can lead to several complications, including compartment syndrome and osteomyelitis. Most open fractures are uncomplicated, but that doesn’t antibiotic prophylaxis is warranted. Wounds should be irrigated and patients should be given a tetanus shot if not uptodate.


We base our grades on the Gustilo Classification, which takes into account length, severity, and exposure. Staphylococcus and streptococcus sp and other skin flora are the target organisms for Grade I and II. These fractures are less than 10 cm, and cefazolin is indicated. Grade III open fractures are greater than 10 cm and have subcategories that consider type of exposure and extensive vascular injury.The EAST guidelines recommend have recommend cefazolin/gentamicin due to prior studies showing worse outcomes in Grade III open fractures without expanded gram negative coverage. Ceftriaxone is a reasonable alternative without increasing rates of infection, while minimizing use of aminoglycosides. If exposed to farm or contaminated soil, coverage of Clostridium is required. Agents to consider include PCN, metronidazole, or clindamycin. Hungry for more PHARMFAX? Check out another video on my page, share the PHARMFAX with a friend, and I hope you learned something new.


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