Algorithm
- ATLS; photograph wound if possible before covering.
- IV antibiotics within 1 hour — co-amoxiclav or cefazolin + gentamicin.
- Tetanus prophylaxis per immunization status.
- Sterile saline-soaked dressing; skeletal stabilization; do not probe wound in ED.
- Urgent orthoplastics — debridement and fixation per Gustilo grade.
Red flags
- • Gross contamination or delayed presentation — escalate ortho/ID
- • Compartment syndrome signs
- • Hemodynamic instability — ATLS priorities first
Medications by step
Step 1 — Antibiotics (within 1 h)
- Co-amoxiclav · i.v.
1.2 g IV
- Cefazolin + Gentamicin · i.v.
2 g + 5 mg/kg IV
Step 2 — Tetanus
- Tetanus toxoid / immunoglobulin · i.m.
Per immunization status
References
- • BOAST — Open fractures (2020)
Updated: Июль 2026