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Antibiotics for pelvic fracture

Ben Reynolds aneurysm_42 at yahoo.com
Fri Apr 14 22:47:59 BST 2006


Having read everyone's posts, I just want to clarify a
few issues for the readers in such a way which doesn't
drag me into this discussion.  It seems that the
debating parties aren't speaking the same language:

1.  Surgery within the pelvis as performed by an
OB/GYN and surgery on a fracture of the pelvis as
performed an orthopedic surgeon are not the same
thing. 

2.   Perioperative antibiotic prophylaxis for pelvic
surgery as performed by an OB/GYN and for fractures of
the pelvis as performed by an orthopedic surgeon
aren't the same.  The organisms you are trying to
cover for in those two situations aren't the same,
ergo they mandate different coverage.

3.  Pelvic fractures are sterile unless they are open
or penetrate a hollow viscus (not including the
bladder which is sterile) an event which occurs at a
rate not exceeding 1%; this is why we do rectal and
vaginal exams to ensure that a suspicious fracture
hasn't violated those areas.  When open pelvic
fractures do occur it is rare that they aren't
heralded by OBVIOUS clinical stigmata.

4.  When open pelvic fractures occur, just as with ANY
open fracture (femur, humerus, etc.) no amount of
antibiotics will prevent infection or decrease the
risk of sepsis.  Immediate irrigation and debridement
of the open fracture is mandated and depending on the
situation, repeated and serial irrigation and
debridements may be necessary.  Massive doses of
antibiotics do not aid in mechanically removing
infectious burden, debris, or devitalized muscle and
bone which are the nidus of sepsis in these
situations; similarly, massive doses of antibiotics
cannot STERILIZE this debris either.

I hope this helps.

Ben Reynolds, PA-C
Pittsburgh, PA

--- Krin135 at aol.com wrote:

>  
> In a message dated 14-Apr-06 11:19:56 Central
> Daylight Time,  
> docrickfry at aol.com writes:
> 
> SIGHHHHH...
> Do you not get it yet?  Of course, once again, 
> listen to this----yes, 
> prophylactic antibiotics DO work to reduce the 
> incidence of postop wound 
> infections--they have NOT ever been shown to prevent
>  infictuous complications of pelvic 
> fractures--it seems pretty simple a concept  to me
> to get your arms around
> ERF 
> 
> 
>  
> OK...I must have missed something, because I was 
> under the impression that 
> the question involved a pelvic fracture needing some
>  sort of OPERATIVE 
> management....
>  
>  
> Charles S. Krin, DO  FAAFP
> 
> --
> trauma-list : TRAUMA.ORG
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