Open fractures

Question 1

What are the grades outlined by the Gustilo-Anderson open fracture classification scheme?

Answer 1

Type 1: open fracture with wound smaller than 1cm.
Type II: open fracture with wound larger than 1cm but intact soft tissues.
Type IIIa: open wound with significant soft tissue disruption but adequate coverage.
Type IIIb: open fracture with extensive soft tissue loss.
Type IIIc: neurovascular damage requiring repair

Question 2

What antimicrobial treatment is recommended based on GusAnderson-open fracture grade

Answer 2

Types I and II: first or second generation cephalosporin.
Types III: 1st/2nd gen cephalosporin and fluoroquinolone

Question 3

What bacteria are most commonly isolated from initial wound cultures?

Answer 3

Stap, strep, klebsiella, pseudomonas, e-coli, enterobacter, clostridium