Presenter discusses infection risk, management of open fractures

BOULDER, Colo. — Although the risk of infection may increase with open fracture, early administration of prophylactic antibiotics may decrease this risk, according to a speaker at the International Extreme Sports Medicine Congress.

“So, open fractures are at a higher risk of developing infection and the higher the type or grade, the higher risk of probably getting an infection,” Jason W. Stoneback, MD, said during his presentation.

Based on Gustilo-Anderson classification, he noted type 1 open fractures have a 1% infection rate compared with type 3c, which may be about 25%. Stoneback said risk for infection is decreased with prophylactic antibiotics and that early administration is crucial for mitigating infection.

“Our protocol is within 1 hour of presenting to our department, and [patients] must receive prophylactic antibiotics during that time,” he said.

Stoneback said patients should also receive antibiotics after debridement or until the wound closed. Multidisciplinary teams may decrease time to antibiotic use, according to Stoneback.

“[Our] multidisciplinary team meets with [the] emergency department and all involved parties to make sure we have protocols and pathways in place to make sure this is happening in a timely fashion,” he said.

One major change physicians are putting into practice is use of third-generation cephalosporin instead of gentamicin in type 3 open fractures because third-generation cephalosporin is less nephrotoxic, according to Stoneback.

He said that if a patient has a vascular injury or pending compartment syndrome, the open fracture should be washed out. If the fracture is more severe, physicians should perform irrigation and debridement within 24 hours.

“So [in] open fracture, just because the fracture hematoma has been disturbed they are at a higher risk for delayed union and nonunion as compared to closed fractures,” Stoneback said. “[Once] ... there is an infection, then that also puts us into a significant disadvantage and causes an increased risk of nonunion.”

Simple open fractures can be treated with nails; however more complex fractures may be treated with fixation, according to Stoneback. – by Monica Jaramillo

Reference:

Stoneback JW. Guidelines for treatment of open fractures in the field and in a level-1 trauma center. Presented at: International Extreme Sports Medicine Congress; June 1-2, 2018; Boulder, Colorado.

Disclosure: Stoneback reports no relevant financial disclosures.