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Gustilo-Anderson Grade I
- <1cm long
- clean wound
- minimal soft tissue injury
- simple fracture with minimal comminution
Treatment
- IV antibiotics. Cefazolin 2 grams IV Q8hrs for 3 days. (Wilkins J, Orthop Clin North Am 1991;22:433). Clindamycin 600mg IV Q8hrs in PCN allergic.
- Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown.
- Photograph the injury.
- Operative debridement.
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Gustilo-Anderson Grade II
- >1cm long
- moderate contamination
- moderate soft tissue damage
- moderate comminution
Treatment
- IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. (Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
- Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
- Photograph the injury.
- Operative debridement.
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Gustilo-Anderson Grade IIIA
- >10cm long
- highly contaminated
- Severe soft tissue injury with cruching, but wound soft tissue coverage is possible
- Usually comminuted
Treatment
- IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. Add penicillin for any wound heavily contaminated with soil.(Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
- Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
- Photograph the injury.
- Operative debridement.
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Gustilo-Anderson Grade IIIB
- >10cm long
- highly contaminated
- Very severe soft tissue injury usually requiring reconstructive surgery for coverage
- May be severely comminuted
- IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. Add penicillin for any wound heavily contaminated with soil.(Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
- Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
- Photograph the injury.
- Operative debridement.
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Gustilo-Anderson Grade IIIC
- >10cm long
- highly contaminated
- Very severe soft tissue injury with vascular injury requiring repair; usually requires reconstructive surgery for coverage
- May be severely comminuted
- IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. Add penicillin for any wound heavily contaminated with soil.(Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
- Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
- Photograph the injury.
- Operative debridement.
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