Review Question - QID 4580

The scenario described above is of a type II open fracture, and current initial recommendations for these injuries include tetanus prophylaxis/update and a first generation cephalosporin (if no allergies).

Hauser et al review the literature on antibiotics and open fractures. They note that use of first-generation cephalosporins, along with appropriate fracture care, minimize risk of infection. They also state that current treatment is often rooted in old (>30 years) low-level data.

Saveli et al report that although methicillin-resistant Staphylococcus aureus (MRSA) is increasingly common, no evidence exists to recommend for use of MRSA prophylaxis. They recommend selecting antibiotics against MRSA for these open fractures only if significant prevalence of MRSA carriers is seen or other risk factors are present.

Zalavras et al review open fracture treatment protocols and state that although controversy exists regarding optimal treatment of open fractures, immediate intravenous antibiotic administration should be done in order to minimize infection. They also report that the goals of treatment of these injuries are the prevention of infection, union of the fracture, and restoration of function.

Figure A shows an isolated tibial shaft fracture.

Incorrect Answers:
Answer 1: Fluoroquinolones can be used in these injuries as second-line agents if allergies are present.
Answer 2: Vancomycin is not currently recommended as a first-line agent for prophylaxis.
Answer 3: Penicillin can be added in contaminated type III injuries.
Answer 4: Gentamycin can be added in type III injuries.