A 20-year-old male presents to your ED with a 5 cm wound after he fell off his motorbike. On physical exam, the wound overlays a fractured left tibia but does not show extensive soft tissue damage nor any signs of periosteal stripping or vascular injury.
Which antibiotic should you give to this patient?
To learn more about it, read chapters below.
Read "Scores" Chapter
Read "Lower Extremity Injuries" Chapter
Gustilo-Anderson classification is used for fractures with open wounds and antibiotic coverage.
|Type I||Open fracture, clean wound, wound <1cm in length|
|Type II||Open fracture, wound >1cm in length without extensive soft tissue damage, flaps, avulsions|
|Type III||Open fracture with extensive soft tissue laceration, damage, or loss or an open segmental fracture. This type also includes open fractures caused by farm injuries, fractures requiring vascular repair, or fractures that have been open for 8 hours prior to treatment.|
|Type III A||Type III fracture with adequate periosteal coverage of the fractured bone despite extensive soft tissue laceration or damage|
|Type III B||Type III fracture with extensive soft tissue loss and periosteal stripping and bone damage. Usually associated with massive contamination. It will often need further soft tissue coverage procedure (i.e. free or rotational flap).|
|Type III C||Type III fracture associated with arterial injury requiring repair, irrespective of degree of soft tissue injury|
According to the above classification, each class should receive the following antibiotics:
- Type I: 1st generation cephalosporin
- Type II: 1st generation Cephalosporin +/- Gentamycin
- Type III: 1st generation Cephalosporin + Gentamycin +/- Penicillin