Management of open fractures in adult patients: current teaching in ACGME accredited residency programs

The purpose of this study is to determine the methods of treatment for open fractures that are currently used by academic orthopaedic residency programs. A Web-based survey was constructed and e-mailed to program directors of orthopaedic residencies. Seventy-four programs out of a total of 140 (53%) surveyed programs responded. Data were tabulated and charts were created in an Excel spreadsheet. Type I fractures were treated by most with a cephalosporin alone (99%) for less than 48 hours (86%). Type II fractures were treated by most programs with a cephalosporin alone with no aminoglycoside (85%) for less than 48 hours (81%). Type IIIa fractures were treated by most programs with a cephalosporin and an aminoglycoside (55%) for less than 48 hours (54%). Type IIIb fractures were treated by most with a cephalosporin and aminoglycoside (55%) for less than 48 hours (54%). Type IIIc fractures were also treated by most with a cephalosporin and an aminoglycoside (57%) for less than 48 hours (49%). Wounds were closed by most responders for type I (88%), type II (86%), and type IIIa (57%), but not type IIIb (5%) and type IIIc (11%) fractures. Fifty-four percent of programs reported having trauma rooms and 58% of programs allow residents to irrigate and débride wounds in the emergency room. The study concluded that most orthopaedic residencies utilize a cephalosporin alone for types I and II open fractures with an aminoglycoside added for type III fractures. Antibiotic treatment is typically given for 48 hours or less. A delay of 6 hours is accepted for types I and II fractures but not type III fractures.