Open Extremity Fractures - Guidelines for the Initial Evaluation of the Adult Trauma Patient
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The Open Fracture Algorithm is as follows:
| Orthopedic response within 30 minutes of arrival time. Page resident with injury and trauma classification |
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| Dressing should be 0.9NS soaked gauze & wrapped with Ace wrap |
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Do not open site more than twice. |
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| All patients will be evaluated for updated tetanus prophylaxis |
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Open fracture grade |
Characteristics of Gustilo Grade Open Fracture |
Infection Rate |
Amputation Rate |
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|---|---|---|---|---|
|
Grade I |
Clean wound smaller than 1 cm in diameter, simple fracture pattern, no skin crushing. |
0-2% |
0% |
|
|
Grade II |
A laceration larger than 1 cm but without significant soft tissue crushing, including no flaps, degloving, or contusion. Fracture pattern may be more complex. |
2-7% |
0% |
|
|
Grade III |
An open segmental fracture or a single fracture with extensive soft tissue injury. Type III injuries are divided into three subtypes: |
|
|
|
|
Grade III A |
Adequate soft tissue coverage of the fracture despite high energy trauma or extensive laceration or skin flaps. |
5-10% |
2.5% |
|
|
Grade III B |
Inadequate soft tissue coverage with periosteal stripping. Soft tissue reconstruction is necessary. |
10-50% |
5.6% |
|
|
Grade III C |
Any open fracture that is associated with an arterial injury that requires repair. |
25-50% |
25% |
|
|
Grade of Open Fx |
Recommended Antibiotic |
Alternate if PCN Allergy |
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|
I or II |
Kefzol 1-2 g load then 1g IV q8h for 48 hrs |
Clindamycin 900 mg IV q8h for 48 hrs |
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III |
Ceftriaxone 1g IV then repeat q24h for 48 hrs |
Clindamycin 900 mg IV q8h and Aztrenonam 1g IV q8h for 48hrs |
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