[Treatment of type II B open fracture--therapeutic regimen and results]

A consecutive series of 119 type III B compound fractures in 103 patients was treated at the University of Louisville from May 1983 to May 1989. All patients had timely irrigation of their wounds, serial wound debridements, external skeletal stabilization and parenteral systemic antibiotics (penicillin, cefazolin, tobramycin). 96 open fractures were managed with the supplemental local use of tobramycin-PMMA-beads. There were 13.5% wound infections and 10.1% osteomyelitis observed. The additional local antibiotic therapy was of significant (p less than 0.001, p less than 0.025) benefit to lower both infectious complications. The amputation rate was overall 5%, 9.7% for the lower leg. Four patients died due to multiple trauma.