Abstract
Background
Scant evidence exists to support antibiotic use for low velocity ballistic fractures (LVBF). We therefore sought to define current practice patterns. We hypothesized that most surgeons prescribe antibiotics for LVBF, prescribing is not driven by institutional protocols, and that decisions are based on protocols utilized for blunt trauma.
Materials and methods
A web-based questionnaire was emailed to the membership of the Orthopaedic Trauma Association (OTA). The questionnaire included demographic information and questions about LVBF treatment practices. Two hundred and twenty surgeons responded. One hundred and fifty-four (70 %) respondents worked at a Level-1 trauma center, 176 (80 %) had received fellowship education in orthopaedic trauma and 104 (47 %) treated at least 10 ballistic fractures annually. Responses were analyzed with SAS 9.3 for Windows (SAS Institute Inc, Cary, NC).
Results
One hundred eighty-six respondents (86 %) routinely provide antibiotics for LVBF. Those who did not were more apt to do so for intra-articular fractures (8/16, 50 %) and pelvic fractures with visceral injury (10/16, 63 %). Most surgeons (167, 76 %) do not believe the Gustilo–Anderson classification applies to ballistic fractures, and (20/29, 70 %) do not base their antibiotic choice on the classification system. Few institutions (58, 26 %) have protocols guiding antibiotic use for LVBF.
Conclusions
Routine antibiotic use for LVBF is common; however, practice is not dictated by institutional protocol. Although antibiotic use generally follows current blunt trauma guidelines, surgeons do not base their treatment decisions the Gustilo–Anderson classification. Given the high rate of antibiotic use for LVBF, further study should focus on providing evidence-based treatment guidelines.
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References
Gustilo RB (1979) Use of antimicrobials in the management of open fractures. Arch Surg 114(7):805–808
Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg (American volume) 58(4):453–458
Patzakis MJ, Harvey JP, Jr, Ivler D (1974) The role of antibiotics in the management of open fractures. J Bone Joint Surg (American volume) 56(3):532–541
Hampton OP Jr (1961) The indications for debridement of gun shot (bullet) wounds of the extremities in civilian practice. J Trauma 1:368–372
Howland WS, Jr, Ritchey SJ (1971) Gunshot fractures in civilian practice. An evaluation of the results of limited surgical treatment. J Bone Joint Surg (American volume) 53(1):47–55
Hopkinson DA, Marshall TK (1967) Firearm injuries. Br J Surg 54(5):344–353
Thoresby FP, Darlow HM (1967) The mechanisms of primary infection of bullet wounds. Br J Surg 54(5):359–361
Wolf AW, Benson DR, Shoji H, Hoeprich P, Gilmore A (1978) Autosterilization in low-velocity bullets. J Trauma 18(1):63
DeMuth WE Jr (1966) Bullet velocity and design as determinants of wounding capability: an experimental study. J Trauma 6(2):222–232
Knapp TP, Patzakis MJ, Lee J, Seipel PR, Abdollahi K, Reisch RB (1996) Comparison of intravenous and oral antibiotic therapy in the treatment of fractures caused by low-velocity gunshots. A prospective, randomized study of infection rates. J Bone Joint Surg (American volume) 78(8):1167–1171
Geissler WB, Teasedall RD, Tomasin JD, Hughes JL (1990) Management of low velocity gunshot-induced fractures. J Orthop Trauma 4(1):39–41
Dickey RL, Barnes BC, Kearns RJ, Tullos HS (1989) Efficacy of antibiotics in low-velocity gunshot fractures. J Orthop Trauma 3(1):6–10
Dougherty PJ, Vaidya R, Silverton CD, Bartlett C, Najibi S (2009) Joint and long-bone gunshot injuries. J Bone Joint Surg (American volume) 91(4):980–997
Simpson BM, Wilson RH, Grant RE (2003) Antibiotic therapy in gunshot wound injuries. Clin Orthop Relat Res 408:82–85
Papasoulis E, Patzakis MJ, Zalavras CG (2013) Antibiotics in the treatment of low-velocity gunshot-induced fractures: a systematic literature review. Clin Orthop Relat Res 471(12):3937–3944
Knapp PE, Saltzman JR, Fairchild P (1996) Acalculous cholecystitis associated with microsporidial infection in a patient with AIDS. Clin Infect Dis: Off Publ Infect Dis Soc Am 22(1):195–196
Campbell KA, Stein S, Looze C, Bosco JA (2014) Antibiotic stewardship in orthopaedic surgery: principles and practice. J Am Acad Orthop Surg 22(12):772–781
Chen AF, Schreiber VM, Washington W, Rao N, Evans AR (2013) What is the rate of methicillin-resistant Staphylococcus aureus and Gram-negative infections in open fractures? Clin Orthop Relat Res 471(10):3135–3140
Norton TD, Skeete F, Dubrovskaya Y, Phillips MS, Bosco JD 3rd, Mehta SA (2014) Orthopedic surgical site infections: analysis of causative bacteria and implications for antibiotic stewardship. Am J Orthop 43(5):E89–E92
Tosti R, Samuelsen BT, Bender S et al (2014) Emerging multidrug resistance of methicillin-resistant Staphylococcus aureus in hand infections. J Bone Joint Surg (American volume). 96(18):1535–1540
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Marecek, G.S., Earhart, J.S., Gardner, M.J. et al. Surgeon preferences regarding antibiotic prophylaxis for ballistic fractures. Arch Orthop Trauma Surg 136, 751–754 (2016). https://doi.org/10.1007/s00402-016-2450-8
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DOI: https://doi.org/10.1007/s00402-016-2450-8