Initial Antibiotic Care Following Severe Open Gunshot Fractures
Location
LSUHSC-NO Center for Advanced Learning and Simulation
Document Type
Presentation
Start Date
21-6-2025 10:20 AM
End Date
21-6-2025 11:15 AM
Publication Date
June 2025
Description
Introduction: Gunshot injuries are a common and expensive cause of trauma care for our local population. Among patients who are seen for trauma care in New Orleans, nearly 60% require orthopaedic surgery consultation secondary to gun shot bone and soft tissue injuries. Recommended care for gunshot fractures is mixed with regards to how the resultant wound should be treated; and the surgeon’s perceived severity of the open wound likely influences how aggressive wound care including antibiotic coverage is delivered. Published outcomes are variable for bone fractures sustained due to gunshot injury in part because the resultant injury and concomitant injuries are highly variable. The purpose of this study is to describe antibiotic use patterns and complications following gunshot extremity fractures resulting in severe wounds.
Methods: This retrospective cohort study identified patients with severe open lower extremity fractures (Gustilo and Anderson grade 3) using the electronic medical record. Demographics and mechanisms of injury were then abstracted where mechanisms were categorized as blunt versus penetrating trauma. Pre-hospital and emergency department antibiotics were abstracted. Initial antibiotic care for both blunt and penetrating resultant injuries was tested for association with fracture related infections.
Results: Two-hundred and sixty-nine grade 3 open lower extremity fractures were included. Eighteen percent (49/269) were the result of penetrating trauma. Of these, 35% (17/49) did not receive pre-hospital or emergency department antibiotics. For the penetrating trauma patients who did receive pre-hospital or emergency department antibiotics (65%, 32/49), most received gram positive coverage (56%,18/32) while 28% (9/32) received both gram positive and gram negative coverage. Penetrating trauma related fractures tended to have a lower odds of having pre-hospital or emergency department antibiotics administered (65% versus 74%, 162/220) but when having had antibiotics administered were as likely to have administered both gram positive and gram negative coverage (28% versus 26%, 57/220). Despite this, fracture related infection frequencies were essentially the same between open fractures from penetrating trauma (27%, 13/49) versus blunt mechanisms (25%, 55/220).
Discussion: While initial antibiotic care is controversial in the treatment of gunshot related fractures, this study examined antibiotic care for those fractures specifically with severe wounds. Despite including documentation of a grade 3 open fracture, not all patients had documentation of pre-hospital or emergency department antibiotics. Furthermore, gram positive monotherapy was the most common despite open fracture antibiotic recommendations, a finding which is consistent with recent results published by Lin et al. This tended to be more frequent in patients with penetrating injuries compared to blunt trauma. Regardless of initial antibiotic care or injury mechanism, fracture related infection rates were found to be similar to previous rates for grade 3 open injuries.
Significance/Clinical relevance: “Infection rate similar regardless of initial care or mechanism, however not all grade 3 open fractures are not receiving antibiotics contrary to recommendations.”
Recommended Citation
Alfred, Michael, "Initial Antibiotic Care Following Severe Open Gunshot Fractures" (2025). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 2.
https://digitalscholar.lsuhsc.edu/ortho_rd/2025/presentation2/2
Initial Antibiotic Care Following Severe Open Gunshot Fractures
LSUHSC-NO Center for Advanced Learning and Simulation
Introduction: Gunshot injuries are a common and expensive cause of trauma care for our local population. Among patients who are seen for trauma care in New Orleans, nearly 60% require orthopaedic surgery consultation secondary to gun shot bone and soft tissue injuries. Recommended care for gunshot fractures is mixed with regards to how the resultant wound should be treated; and the surgeon’s perceived severity of the open wound likely influences how aggressive wound care including antibiotic coverage is delivered. Published outcomes are variable for bone fractures sustained due to gunshot injury in part because the resultant injury and concomitant injuries are highly variable. The purpose of this study is to describe antibiotic use patterns and complications following gunshot extremity fractures resulting in severe wounds.
Methods: This retrospective cohort study identified patients with severe open lower extremity fractures (Gustilo and Anderson grade 3) using the electronic medical record. Demographics and mechanisms of injury were then abstracted where mechanisms were categorized as blunt versus penetrating trauma. Pre-hospital and emergency department antibiotics were abstracted. Initial antibiotic care for both blunt and penetrating resultant injuries was tested for association with fracture related infections.
Results: Two-hundred and sixty-nine grade 3 open lower extremity fractures were included. Eighteen percent (49/269) were the result of penetrating trauma. Of these, 35% (17/49) did not receive pre-hospital or emergency department antibiotics. For the penetrating trauma patients who did receive pre-hospital or emergency department antibiotics (65%, 32/49), most received gram positive coverage (56%,18/32) while 28% (9/32) received both gram positive and gram negative coverage. Penetrating trauma related fractures tended to have a lower odds of having pre-hospital or emergency department antibiotics administered (65% versus 74%, 162/220) but when having had antibiotics administered were as likely to have administered both gram positive and gram negative coverage (28% versus 26%, 57/220). Despite this, fracture related infection frequencies were essentially the same between open fractures from penetrating trauma (27%, 13/49) versus blunt mechanisms (25%, 55/220).
Discussion: While initial antibiotic care is controversial in the treatment of gunshot related fractures, this study examined antibiotic care for those fractures specifically with severe wounds. Despite including documentation of a grade 3 open fracture, not all patients had documentation of pre-hospital or emergency department antibiotics. Furthermore, gram positive monotherapy was the most common despite open fracture antibiotic recommendations, a finding which is consistent with recent results published by Lin et al. This tended to be more frequent in patients with penetrating injuries compared to blunt trauma. Regardless of initial antibiotic care or injury mechanism, fracture related infection rates were found to be similar to previous rates for grade 3 open injuries.
Significance/Clinical relevance: “Infection rate similar regardless of initial care or mechanism, however not all grade 3 open fractures are not receiving antibiotics contrary to recommendations.”
Comments
Student and Fellow Presentation