Ways to prevent infection after open fracture of the lower limb

Despite the great effectiveness of antibiotics, no principle is more important in the care of open fractures than aggressive irrigation and debridement. Fixation of open fractures has a number of beneficial effects, including even the reduction of the risk of infection.

This prospective study of the treatment of 116 open fractures of the lower limb offered us the possibility to determine the ways to prevent the infection. All the patients were studied prospectively and the type of treatment and the rate of infection were evaluated.

In the course of the treatment, 96 wounds were closed by primary closure (82.8%) and 2 wounds were closed by secondary closure on the 5(th) postoperative day (1.7%). There were 14 skin grafts (12.1%), 2 muscle flap closures (1.7%) and 2 healings by granulation (1.7%). The antibiotics used were ceftriaxone + gentamycin for type I, II fractures; metronidazole was added for type III fractures. The duration of the antibiotic therapy was 7-10 days, according to the severity of the fracture. The infection rate was 0% for type I, 0% for type II and 5.17% for type III fractures (6/116).

The treatment of open fractures by intensive debridement of the wound and immediate fixation, as well as by primary closure of the wound with prolonged use of antibiotics, led to a dramatic decrease of the rate of infections.