OTD classic article review - Gustillo 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

Orthopedic Trauma Directions 2005; 3(1): 21-27
DOI: 10.1055/s-2005-864195

Bone Joint Surg Am.; 58(4):453-458

Open fractures require emergency treatment including adequate debridement and copious irrigation.
Primary closure is indicated for type I and II fractures. Delayed primary closure, including split thickness skin grafts and appropriate flaps, should be used in type III open fractures.
Internal fixation by plates or intramedullary nails should not be used. External skeletal fixation by skeletal traction or pins above and below the fracture site incorporated in a plaster cast are recommended.
Open fractures associated with arterial injury requiring repair should be treated by skeletal traction whenever possible instead of primary internal fixation.
Antibiotics should be administered before and during surgery. If the wound is closed primarily, the antibiotics are stopped on the third postoperative day. If the wound is closed secondarily, the antibiotics are continued for another three days after this procedure.