The use of antibiotics in the management of open fractures

Successful management of Type III open fractures requires adherence to the following principles: 1) treatment of all open fractures as emergencies; 2) thorough initial evaluation to diagnose other life-threatening injuries; 3) appropriate antibiotic therapy for both grampositive and gram-negative bacteria; 4) adequate debridement and irrigation, with repeat debridement and irrigation in 12 to 48 hours; 5) stabilization of the fractures; 6) appropriate wound coverage; and 7) early cancellous bone grafting. Recent experience has warranted categorizing Type III fractures into subtypes A, B and C, in order of worsening prognosis. The increasing prevalence of infection due to gram-negative organisms is treated by combined use of an aminoglycoside with cefazolin, or ceforanide with amikacin, or a third generation cephalosporin in Type III fractures.