title: Surgeon preferences regarding antibiotic prophylaxis for ballistic fractures.
abstract: BACKGROUND
  Scant evidence exists to support antibiotic use for low velocity ballistic fractures (LVBF). We therefore sought to define current practice patterns. We hypothesized that most surgeons prescribe antibiotics for LVBF, prescribing is not driven by institutional protocols, and that decisions are based on protocols utilized for blunt trauma.
  
  
  METHODS
  A web-based questionnaire was emailed to the membership of the Orthopaedic Trauma Association (OTA). The questionnaire included demographic information and questions about LVBF treatment practices. Two hundred and twenty surgeons responded. One hundred and fifty-four (70 %) respondents worked at a Level-1 trauma center, 176 (80 %) had received fellowship education in orthopaedic trauma and 104 (47 %) treated at least 10 ballistic fractures annually. Responses were analyzed with SAS 9.3 for Windows (SAS Institute Inc, Cary, NC).
  
  
  RESULTS
  One hundred eighty-six respondents (86 %) routinely provide antibiotics for LVBF. Those who did not were more apt to do so for intra-articular fractures (8/16, 50 %) and pelvic fractures with visceral injury (10/16, 63 %). Most surgeons (167, 76 %) do not believe the Gustilo-Anderson classification applies to ballistic fractures, and (20/29, 70 %) do not base their antibiotic choice on the classification system. Few institutions (58, 26 %) have protocols guiding antibiotic use for LVBF.
  
  
  CONCLUSIONS
  Routine antibiotic use for LVBF is common; however, practice is not dictated by institutional protocol. Although antibiotic use generally follows current blunt trauma guidelines, surgeons do not base their treatment decisions the Gustilo-Anderson classification. Given the high rate of antibiotic use for LVBF, further study should focus on providing evidence-based treatment guidelines.
authors.affiliation: Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, 1200 N. State St, GNH 3900, Los Angeles, CA, 90033, USA. marecek@usc.edu.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Marecek
authors.affiliation: Rockford Orthopedic Associates, Rush University Medical Center, Rockford, IL, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Earhart
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Davis
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Merk
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D044709:Forensic Ballistics; D005597:Fractures, Open / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D066231:Surgeons; D011795:Surveys and Questionnaires; D014948:Wounds, Gunshot / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Ballistic fracture; Gunshot wound; Open fracture