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Updated: Jan 7, 2026

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Improving Prophylactic Antibiotic Selection for Type 3 Open Fractures in the Trauma Setting.

Matthew G Van Engen1, Isaac C Talbert1, William M Clune1

  • 1Department of Orthopaedic Surgery, The University of Kansas School of Medicine Wichita, Wichita, Kansas (Van Engen, Talbert, Zimmerman, Behzadpour, Tarrant, Hearon, Dart); The University of Kansas School of Medicine Wichita, Wichita, Kansas (Clune); Office of Research, The University of Kansas School of Medicine Wichita, Wichita, Kansas (Zackula).

Kansas Journal of Medicine
|December 26, 2025
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Summary

A standardized antibiotic protocol significantly improved trauma team members' confidence and knowledge in managing type 3 open fractures. This quality improvement initiative highlights the value of clear guidelines in trauma care.

Keywords:
antibiotic prophylaxiscontinuing medical educationopen fracturequality improvement

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Area of Science:

  • Trauma Surgery
  • Infectious Disease Management
  • Quality Improvement in Healthcare

Background:

  • Open fractures, particularly type 3, require prompt and appropriate antibiotic prophylaxis to prevent infection.
  • Current practices for antibiotic selection in open fractures can be variable, leading to suboptimal outcomes.
  • Standardized protocols are essential for consistent and effective trauma care.

Purpose of the Study:

  • To implement a standardized prophylactic antibiotic protocol for type 3 open fractures.
  • To evaluate the impact of this protocol on trauma team personnel's knowledge and subjective comfort with open fracture management.
  • To assess changes in objective knowledge regarding appropriate antibiotic selection for open fractures.

Main Methods:

  • A simplified prophylactic antibiotic protocol was developed and implemented across two Level 1 trauma centers.
  • Instructional posters detailing the Gustilo classification and approved antibiotic regimens were displayed in trauma bays.
  • Pre- and post-intervention surveys assessed participants' comfort and knowledge of open fracture management, with statistical analysis using Fisher's Exact Test (p <0.05).

Main Results:

  • Participant comfort in selecting antibiotics for type 3 open fractures increased significantly, from 6% to 68% (p <0.001).
  • Correct identification of preferred antibiotic regimens for type 3 open fractures improved by an average of 58% (p <0.001).
  • The study included 16 orthopedic residents and 18 trauma staff members.

Conclusions:

  • A simplified, standardized antibiotic prophylaxis protocol, supported by visual aids, effectively enhances trauma team knowledge and confidence.
  • The findings support the integration of standardized treatment algorithms into emergency department trauma protocols.
  • This quality improvement study demonstrates a successful strategy for optimizing antibiotic use in complex fracture management.