I Think We Need Ancef...

HPI:  Middle age man s/p MCC with open fracture of right leg.  Tourniquet applied in the field.

Physical Exam:  Completely shattered tibia and fibula with 10cm open wound.  Weak but palpable DP after taking tourniquet down.  Intact sensation to light touch in superficial peroneal, deep peroneal, and tibial distributions.  Able to wiggle toes and slight dorsiflexion.

Management:  Basic Management of Open Fractures

• Fracture management starts after initial trauma survey
  
• First generation cephalosporin (we use Ancef 2 gm here) and update tetanus
  
• Control bleeding with direct pressure. Do not blindly clamp or place tourniquets on damaged extremity
  
• Assess soft tissue damage and perform neurovascular exam
  
• Remove large debris and place sterile saline soaked gauze on wound
  
• Splint Fracture

Key Points:  

• Ortho versus Vascular taking to operating room all depends on your detailed neurovascular exam
  
• Early antibiotic administration is the  most important factor in reducing infection
  
• Most important predictor of eventual amputation is the severity of extremity soft tissue injury