From the Guidelines
For coverage post-op bone injury, I strongly recommend using cefazolin or clindamycin for all types of open fractures, with the addition of gram-negative coverage with an aminoglycoside for Gustilo/Anderson Type III (and possibly Type II) open fractures, as this approach has been shown to be effective in preventing surgical site infections 1. When it comes to post-operative care for bone injuries, several key factors must be considered to ensure optimal recovery and minimize the risk of complications.
- Antibiotic prophylaxis is crucial, with cefazolin or clindamycin being the recommended choices for initial coverage 1.
- The use of local antibiotic strategies as an adjunct has also received a moderate strength recommendation, with options including vancomycin powder, tobramycin-impregnated beads, and gentamicin-covered nails 1.
- Negative pressure wound therapy (NPWT) may be beneficial in certain situations, such as closed fracture fixation after major extremity trauma, to mitigate the risk of developing a surgical site infection 1.
- Pain management should be approached with a multimodal strategy, incorporating scheduled acetaminophen and ibuprofen (if not contraindicated), supplemented with oxycodone as needed for breakthrough pain.
- Wound care should prioritize keeping the surgical site clean and dry, with regular dressing changes and monitoring for signs of infection.
- Follow-up appointments are essential to assess healing and potentially remove sutures or staples, typically scheduled 10-14 days post-operation.
- It is also important to consider the role of surgical timing and the potential benefits of definitive stabilization and primary closure at the time of initial débridement in selected open fractures 1.
From the Research
Coverage Post-Op Bone Injury
- The use of cefazolin as a prophylactic antibiotic in patients with open fractures has been shown to achieve sustained high interstitial concentrations in the injured limb 2.
- A study found that prophylactic post-operative cefazolin for 23 hours did not decrease the risk of surgical site infection (SSI) after open reduction internal fixation (ORIF) of closed extremity fractures 3.
- Cefazolin has been found to be safe for use in penicillin-allergic patients for surgical prophylaxis, with no statistically significant differences in allergic reactions, surgical site infections, or adverse events compared to other antibiotics 4.
- The use of cefazolin as a perioperative antibiotic for infection prophylaxis in total joint arthroplasty in patients labeled beta-lactam allergic is associated with decreased postoperative SSI without an increase in interoperative hypersensitivity reactions 5.
- Inadequate weight-based prophylactic dosing of cefazolin has been found to affect infection rates after spinal fusions, with patients receiving an inadequate dose having an increased risk of infection 6.
Key Findings
- Cefazolin achieves sustained high interstitial concentrations in open fractures 2.
- Prophylactic post-operative cefazolin for 23 hours does not decrease the risk of SSI after ORIF of closed extremity fractures 3.
- Cefazolin is safe for use in penicillin-allergic patients for surgical prophylaxis 4.
- Cefazolin reduces postoperative SSI in total joint arthroplasty in patients labeled beta-lactam allergic 5.
- Inadequate weight-based prophylactic dosing of cefazolin increases the risk of infection after spinal fusions 6.