Orthobullets Trauma

Question 1

open fracture rx

Answer 1

• Nonoperative
  
  • emergent IV antibiotics, tetanus, and extremity stabilization and dressing
    
    • indications
      
      • initial treatment for all open fractures
        
        • a soft tissue wound in proximity to a fracture should be treated as an open fracture until proven otherwise
      • antibiotic type indicated by injury pattern and location (see technique below)
• Operative
  
  • urgent I&D, temporary fracture stabilization, and soft tissue coverage
    
    • indications
      
      • consider I&D as soon as possible, may be beneficial within 6 hours in terms of decreasing infection risk
      • ideal time of soft tissue coverage controversial, but most centers perform within 5 days
  • definitive reconstruction and fracture fixation
    
    • indications
      
      • once soft tissue coverage is obtained and an adequate sterility is achieved