2. 80 years old CF
Chief Complain
Fall
Pain on the Lt elbow
Transferred from another ER with a diagnosis of:
Fracture of the Lt proximal ulna
Open fracture type I.
ID consult : POD # 1
For ABx prophylaxis because of the open fracture type I.
3. PMHx:
Hypertension
Hyperlipidemia
PSHx:
Lt THR (3 years)
Lt Fibula # with plate and I.M nailing. (8 years )
NKDA
No blood transfusion
Meds:
Tenormine 50 mg PO QD
Social Hx:
No Hx Of smoking / ETOH/ elicit drugs
4. Physical Exam:
V/S : 36.8 - 120/76 - 67 – 17
HEENT: Broses on the chin
Chest: CTA bil.
CVS: S1 + S2 + PSM III/VI
ABD: soft, Lax and no tenderness
EXT: no edema , good pulse , Lt upper arm dressed with a cast.
Labs:
WBC = 10.4 , Hb= 12.4, Ht= 37, Plt= 241
Na= 140, K= 4, Cl= 104, CO2= 28, BUN= 15, Cr= 0.5, Glu= 110
5. Dose the patient need Abx prophylaxis?
If yes, what Abx should be used & for how long?
What else should be considered apart from Abx prophylaxis?
7. • Wound less than 1 cm,
• without contamination
• minimal injury of soft
tissue.
8. • Wound between 1 -10 cm
• mild contamination
• extensive soft tissue damage and
moderate crushing component.
9. • Wound larger than 10 cm
• severe contamination
• severe crushing component.
10. antibiotics “Gram Positive coverage” should be started as soon as possible
after injury and continued for 3 days*
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100
11. antibiotics “Gram Positive coverage” should be started as soon as
possible after injury and continued for 3 days*
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100
12. antibiotics “Gram Positive coverage” should be started as soon as
possible after injury and continued for 5 days*
combined with local therapy consisting of antibiotic-impregnated
polymethylmethacrylate beads
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100