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Sat Apr 15 18:23:04 BST 2006

In a message dated 15-Apr-06 12:12:19 Central Daylight Time,  ben
sonblues at comcast.net writes:

Dr.  Ricky, 
It is you not getting it. The discussion was about a patient with  an 
acetabular fracture, remember? We operate on that here in Detroit. Oh, yes,  and they 
get prophylactic antiobiotics. What a babbling fool. You need to take  your 
lithium, buddy.
DB

I'm taking the liberty of compiling the  responses from Claudia and the 
others into an article that I intend to submit to  Karim for inclusion in the 
Trauma Wiki. While I'm waiting to get the full text  of several articles that I 
intend to use as reference, I believe that I can sum  up what both a bit of 
MedLine research and several members of this august group  have tried to explain...

In pelvic trauma, IF there is NO skin  breach AND NO internal organ damage 
(i.e., a pure acetabular fracture) AND  appropriate debriedment of any 
devitalized tissue is carried out (including but  not limited to a thorough irrigation 
prior to closure),  THEN there is  no need for antibiotics as 'prophylaxis'. 
Appropriate intraoperative and blood  cultures should be carried out, and the 
wound watched for infection, just as if  it were an elective hip replacement.

IF there is a contaminating skin breach OR  internal organ damage, the first 
priority is to accomplish a mechanical toilet  via appropriate and complete 
debriedment and lavage, with anatomical closure or  a diverting stoma as needed. 
Consideration of prophylatic antibiotics (ranging  from one intraoperative 
dose to a short (less than 5 day) course of antibiotics  MAY be of some help in 
this case, based on studies done involving 'elective'  colorectal and gyn 
surgery.

Hope I am understanding and explaining the  situation a bit better.

ck

Charles S. Krin, DO  FAAFP

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Prophylactic antibiotics