title: Management of open fractures in adult patients: current teaching in ACGME accredited residency programs.
abstract: The purpose of this study is to determine the methods of treatment for open fractures that are currently used by academic orthopaedic residency programs. A Web-based survey was constructed and e-mailed to program directors of orthopaedic residencies. Seventy-four programs out of a total of 140 (53%) surveyed programs responded. Data were tabulated and charts were created in an Excel spreadsheet. Type I fractures were treated by most with a cephalosporin alone (99%) for less than 48 hours (86%). Type II fractures were treated by most programs with a cephalosporin alone with no aminoglycoside (85%) for less than 48 hours (81%). Type IIIa fractures were treated by most programs with a cephalosporin and an aminoglycoside (55%) for less than 48 hours (54%). Type IIIb fractures were treated by most with a cephalosporin and aminoglycoside (55%) for less than 48 hours (54%). Type IIIc fractures were also treated by most with a cephalosporin and an aminoglycoside (57%) for less than 48 hours (49%). Wounds were closed by most responders for type I (88%), type II (86%), and type IIIa (57%), but not type IIIb (5%) and type IIIc (11%) fractures. Fifty-four percent of programs reported having trauma rooms and 58% of programs allow residents to irrigate and débride wounds in the emergency room. The study concluded that most orthopaedic residencies utilize a cephalosporin alone for types I and II open fractures with an aminoglycoside added for type III fractures. Antibiotic treatment is typically given for 48 hours or less. A delay of 6 hours is accepted for types I and II fractures but not type III fractures.
authors.affiliation: Department of Orthopedic Surgery, Albany Medical College, 1367 Washington Ave., Albany, NY 12206, USA. lavellwf@yahoo.com
authors.forename: William F
authors.initials: WF
authors.lastname: Lavelle
authors.forename: Richard
authors.initials: R
authors.lastname: Uhl
authors.forename: Michael
authors.initials: M
authors.lastname: Krieves
authors.forename: David M
authors.initials: DM
authors.lastname: Drvaric
mesh_terms: D000046:Academic Medical Centers; D000068:Accreditation; D000328:Adult; D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D003646:Debridement; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D005597:Fractures, Open / Q000145:classification / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D009985:Orthopedics / Q000193:education*; D007507:Therapeutic Irrigation; D013997:Time Factors; D014193:Trauma Centers
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins