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)