Orthopedic Trauma Open Fracture Antibiotic Guidelines

Classification:

Gustilo-Anderson Classification of Open Fractures
Type Details

I. Open fracture with a wound less than 1 cm long, low energy, without gross contamination
II. Open fracture with a wound 1–10 cm long, low energy, without gross contamination or extensive soft-tissue damage, flaps, or avulsions
III.  1. A: Open fracture with a wound greater than 10 cm with adequate soft-tissue coverage, or any open fracture due to high-energy trauma or with gross contamination, regardless of the size of the wound
2. B: Open fracture with extensive soft-tissue injury or loss, with periosteal stripping and bone exposure that requires soft-tissue coverage in the form of muscle rotation or transfer
3. C: Open fracture associated with arterial injury requiring repair

Antibiotic Guidelines:
Gustilo Type I and II:
Cefazolin 2g IV immediately and q8 hours x 3 total doses
If penicillin allergic: clindamycin 900mg IV immediately and q8 hours x 3 total
doses

Gustilo Type III:
Ceftriaxone 2g IV immediately x 1 total dose
Vancomycin 1g IV immediately and q12 hours x 2 total doses

Additional Antibiotics required for the following circumstances:
– Freshwater – fluoroquinolone
– Saltwater – doxycycline
– Fecal/Barnyard contamination – high dose penicillin

**Doses and regimens are adjusted based on patient weight and allergies when indicated.

Evidence:
Garner, Matthew R. MD; Sethuraman, Saranya A. MD; Schade, Meredith A. MD; Boateng, Henry MD Antibiotic Prophylaxis in Open Fractures: Evidence, Evolving Issues, and Recommendations, Journal of the American Academy of Orthopaedic Surgeons: April 15, 2020 – Volume 28 – Issue 8 – p 309-315 doi: 10.5435/JAAOS-D-18-00193