From the Guidelines
Open finger fractures should be treated with immediate surgical intervention, including thorough irrigation and debridement, fracture stabilization, and antibiotic prophylaxis with systemic cefazolin or clindamycin, as recommended by the American Academy of Orthopaedic Surgeons 1. The treatment approach involves a combination of surgical intervention, antibiotics, and wound care to minimize the risk of infection and promote healing.
- Surgical intervention should be performed as soon as reasonable, ideally within 24 hours post-injury, to reduce the risk of infection 1.
- Antibiotic therapy should be started promptly, with a first-generation cephalosporin like cefazolin (1-2g IV every 8 hours) or clindamycin (600-900mg IV every 8 hours) for penicillin-allergic patients, and continued for 24-72 hours after surgery.
- Fracture stabilization can be achieved through various methods, including K-wires, plates, screws, or external fixators, depending on the fracture pattern.
- Tetanus prophylaxis should be administered if the patient's immunization status is outdated or unknown.
- Following surgical intervention, the finger should be immobilized with a splint to protect the repair while allowing for wound assessment, and regular follow-up is essential to monitor for infection and evaluate bone healing.
- Early physical therapy is crucial to prevent joint contractures and maintain mobility, and should be initiated as soon as possible after surgery. The goal of treatment is to minimize morbidity, mortality, and improve quality of life by preventing infection, promoting healing, and restoring function to the affected finger.
- The choice of antibiotic prophylaxis may vary depending on the severity of the fracture and the presence of contamination, with additional gram-negative coverage preferred for Type III open fractures 1.
- Local antibiotic prophylactic strategies, such as vancomycin powder or gentamicin-covered nails, may also be beneficial in reducing the risk of surgical site infection 1.
From the Research
Treatment of Open Finger Fractures
The treatment of open finger fractures involves a combination of antibiotic therapy, wound management, and fracture stabilization.
- Early, systemic, wide-spectrum antibiotic therapy is necessary for the treatment of open fractures, as stated in 2 and 3.
- The open fracture wound should be thoroughly débrided, and the use of local antibiotic administration is a useful adjunct, as mentioned in 2 and 3.
- Techniques of fracture stabilization depend on the anatomic location of the fracture and characteristics of the injury, as stated in 2 and 3.
- Extensive soft-tissue damage may necessitate the use of local or free flaps, as mentioned in 2 and 3.
Antibiotic Therapy
- Wide-spectrum antibiotic therapy should be incorporated into the treatment plan, as stated in 4.
- Antibiotics should be initiated as soon after injury as possible, preferably within 3 hours of injury, as mentioned in 5 and 4.
- The selection of antibiotics depends on the grade of open fracture, with Grade I and II open fractures requiring a first-generation cephalosporin, and Grade III open fractures requiring coverage with an aminoglycoside in addition to a first-generation cephalosporin, as stated in 5.
Wound Management
- The open fracture wound should be thoroughly irrigated and debrided, as mentioned in 3.
- The use of a bead pouch technique can deliver antibiotics locally and prevent secondary wound contamination, as stated in 2.
- The wound should not be closed to avoid the complication of gas gangrene, as mentioned in 2.
Specific Considerations for Open Finger Fractures
- Current guidelines suggest early surgical treatment of open fractures, but this rule may not be well supported for open hand fractures, as stated in 6.
- Desirable debridement and washout can be obtained in the emergency department, as mentioned in 6.
- The amount of fluid used for washout and the type of oral antibiotic were significant factors in preventing infection, as stated in 6.