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A 32-year-old male sustained a right grade IIIB open tibial shaft fracture 10 months ago when he fell down a ledge while hiking. Due to the location of the injury, it took EMS 15 hours to transport the patient to the ED, where IV antibiotics were promptly started. Subsequently, the patient underwent external fixation with serial debridements followed by definitive flap coverage and unreamed intramedullary nailing six days after the injury. The patient continues to have pain in the leg with weight-bearing but denies any fevers or chills. His surgical wounds appear well-healed with a small sinus tract over the open fracture site. Figures A and B are the current radiographs. Recent labs reveal an ESR, CRP and 25-hydroxyvitamin D2 of 32 mm/hr (reference 0-20 mm/hr), 15 mg/dL (reference 0-3 mg/dL), and 50 ng/mL (reference 20-100 ng/mL). What factor is most likely associated with this patient's current condition?
Delay in definitive wound coverage
Definitive treatment with an unreamed intramedullary nail
Prolonged time to antibiotic administration
Low-pressure irrigation during debridements
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A 24-year-old male presents following a motorcycle crash with an isolated injury to his right lower extremity. He has a 3x2cm wound over the fracture site, and he immediately receives Gram positive and Gram negative coverage along with a tetanus booster. The patient is splinted, optimized, and brought to the operating room where the wound is debrided and classified as a Type IIIB fracture. Deemed stable, the plastic surgery team arrives and acutely performs a free flap for coverage, following definitive fixation with an intramedullary nail. All of the following are factors that have been shown to increase infection risk EXCEPT:
Time to antibiotic administration
Thoroughness of debridement
Time to initial debridement
Ability to close/cover an open wound
Time to definitive fixation
A 25-year-old male presents to the emergency department after a lawnmower accident with traumatic loss of his great toe. On examination, his wound is grossly contaminated with soil. In addition to a cephalosporin and an aminoglycoside, penicillin is given. Which of the following is true with regards to the organism that penicillin is targeting in this injury?
It is an Aerobic, Gram-positive rod
It is an Anaerobic, Gram-positive coccus
It is an Anaerobic, Gram-negative rod
It is Catalase positive
It may cause botulism
A 43-year-old male sustains the injury shown in Figure A. He has an overlying 3 centimeter wound with exposed bone. Which of the following antibiotics is indicated for initial prophylaxis?
A 25-year-old male involved in a motorcyle accident sustains the injury seen in Figures A and B. After initial adequate debridement of nonviable tissue, which of the following irrigation methods and devices should be used?
Antibiotic solution applied by low pressure gravity flow device
Antibiotic solution applied by high pressure pulsatile flow device
Saline solution applied by low pressure gravity flow device
Saline solution applied by high pressure pulsatile flow device
Antibiotic solution applied by high pressure pulsatile flow device followed by low pressure gravity flow device
Which of the following statements is true regarding the outcomes when using a high-pressure pulse lavage irrigation system versus simple low-pressure bulb irrigation for the treatment of the open fracture shown in Figure A?
It is more cost effective when including the cost of reoperation
There is an increased rate of associated nerve injury
There is an increased rate of primary wound healing problems
There is increased rate of infection
There is no difference in union rates
A 8-year-old girl sustained a Gustilo-Anderson grade III open tibia fracture 1 week ago and underwent two debridements with definitive fracture fixation. She now has a soft-tissue defect that measures 7 cm × 7 cm on the distal third leg that is a 3 centimeters proximal to the ankle. There is exposed bone on the medial aspect of her leg. A Negative pressure wound therapy (NPWT) device was applied to her leg. All of the following are benefits of the NPWT EXCEPT:
Decrease likelihood of complex secondary soft tissue reconstruction
Permits outpatient management of complex wound
Reduce edema to wound
Stimulation of granulation tissue
Decreases wound angiogenesis
A 27-year-old man sustains a Gustilo and Anderson type II open tibia fracture during a motorcycle accident. He had a full course of tetanus vaccination as an infant and child. He also had a tetanus booster vaccination 12 months ago when he began a new job. In addition to intravenous antibiotics, what tetanus prophylaxis should be administered?
No prophylaxis required
Tetanus immune globulin
Tetanus vaccine and tetanus immune globulin
Tetanus vaccine and tetanus immune globulin with a booster vaccine required 6 months from now