For this patient, he has a Gustilo Type III open fracture. This requires a bedside washout, fracture stabilization, and immediate antibiotic coverage with cefazolin, metronidazole, and gentamicin. In general, antibiotics should be given within 6 hours of injury, based on the above classification and the patient’s environment they are coming from .
- Type I/II fractures – cover for gram-positive organisms (eg. cefazolin)
- Type III fractures – additionally cover for gram-negative organisms (eg. ceftriaxone or gentamicin)
- Presence of fecal or potential clostridial contamination such as a farm injury – cover for anaerobic coverage (eg. metronidazole)
- Irrigation with NS is sufficient within the ED prior to definitive management .
- Pearl: Patients with comorbidities that affect wound healing have a higher likelihood of infection (>80 years, nicotine use, diabetes, active malignancy, pulmonary insufficiency, and immunocompromised). No comorbidities – 4% risk of infection, 1-2 comorbidities 15%, 3+ comorbidities – 31% risk of infection .
- Pearl: Don’t forget to update the patient’s Tetanus.