Management of open tibia fracture following fresh water contamination

Abstract

The treatment of contaminated open fractures of the tibia remains problematic. Research has shown that the combination of early wound debridement, fracture stabilisation, soft tissue cover and empiric antibiotic use can reduce the incidence of infective complications. Empiric choice of antimicrobial(s) should target the most likely pathogens at the site of infection. Staphylococci and Streptococci are the most common aetiological agents for wound sepsis in the orthopaedic setting, and are typically covered by the first generation cephalosporins. Wound infections secondary to exposure to water sources poses a unique challenge in that a different spectrum of microorganisms are expected and varies according to the type of water source. A recent article published by Ribeiro et al focusing on the management of bums patients, noted that water exposure due to irrigation of the wounds as part of first aid management resulted in Gram-negative colonisation and infection. Thus, different empiric antimicrobials were suggested according to the water sources used for irrigation. Local epidemiology and resistance patterns need to be taken into account when deciding on the initial empiric antibiotic regimen.