title: The prophylactic use of antibiotic impregnated beads in open fractures.
abstract: Four hundred four compound fractures were reviewed in 339 patients treated between August 1983 and November 1987. The 252 males and 87 females had a mean age of 33 years (range, 14-86). One hundred twenty-seven (31.4%) fractures were classified as Grade I, 153 (38.9%) as Grade II, and 124 (30.7%) as Grade III by Gustilo's classification. The mean Injury Severity Score was 15 (range, 9-57). Three hundred thirty-four of the open fractures (82.7%) were managed with antibiotic-impregnated bead chains (tobramycin) and systemic antibiotic prophylaxis (cefazolin, tobramycin, and penicillin). Seventy open fractures (17.3%) received systemic antibiotic prophylaxis (cefazolin, tobramycin, and penicillin) without supplemental use of the antibiotic beads. All open fractures underwent acute irrigation and debridement. In the 404 fractures 46.5% of wounds were closed primarily, 12.9% underwent delayed primary closure, 7.9% were left open, and 32.7% were temporized by the antibiotic bead pouch technique until definitive flap coverage and skin grafting were performed. Of the 404 fractures evaluated, 17 (4.2%) developed an acute wound infection. Of these wound infections, eight (11.4%) were in the group managed with systemic antibiotics alone. By comparison, nine (2.7%) of open fractures treated with combined systemic antibiotics and antibiotic-impregnated beads developed an infection. Chronic osteomyelitis developed in 18 of 404 open fractures (4.5%). Ten (14.3%) open fractures which developed osteomyelitis were managed with systemic antibiotics whereas eight (2.4%) fractures managed with systemic antibiotics and antibiotic-impregnated beads developed a chronic infection.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Humana Hospital, University of Louisville, Kentucky.
authors.forename: S L
authors.initials: SL
authors.lastname: Henry
authors.forename: P A
authors.initials: PA
authors.lastname: Ostermann
authors.forename: D
authors.initials: D
authors.lastname: Seligson
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D005597:Fractures, Open / Q000145:classification / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000517:prevention & control; D014946:Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents