DPDoctor's PassportEducation
Musculoskeletal medicine and orthopaedics indexPassport
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Textbook/Musculoskeletal medicine and orthopaedics/Open fractures and early antibiotic prophylaxis/Rapid
RapidMLAMSRAMRCSFoundation

Open fractures and early antibiotic prophylaxis

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Open fracture with limb threat

Contamination, devitalised tissue, major bleeding, arterial injury and compartment syndrome can cause infection, ischaemia, amputation or death even when the skin wound appears small.

Action: Perform trauma resuscitation, control bleeding, document named nerve and vascular findings, realign and splint if required, give the network-approved intravenous antibiotic immediately and ideally within 1 hour, cover the wound without emergency-department irrigation, and transfer urgently to an orthoplastic-capable centre.

Synopsis

Identify every fracture communicating with a wound, give immediate network-approved intravenous prophylaxis, protect soft tissue and perfusion, and coordinate timely orthoplastic debridement, fixation and cover.

  • Any wound in the same limb segment as a fracture can communicate; document size, site, contamination and photographs before covering, without probing it in the emergency department.
  • Assess pulses, capillary refill and individual motor and sensory nerve function before and after alignment or splintage; hard vascular signs trigger immediate surgical escalation.
  • Give intravenous prophylaxis from the agreed open-fracture network protocol immediately, ideally within 1 hour of injury; record agent, dose and time and modify unusual contamination with microbiology advice.

Key red flags

Absent or deteriorating perfusion, hard vascular signs, uncontrolled bleeding or an ischaemic limb requires immediate combined orthopaedic and vascular intervention without delaying revascularisation for grading.

Investigation priorities

01
First-line orthogonal radiographsFirst stepFirst line

Define fracture, foreign material and joint involvement.

02
Preferred CT angiography when stablePreferred

Assess suspected arterial injury without hard signs requiring immediate operation.

Management branches

First hourProtect life, limb and wound

A fracture-associated wound is present or cannot confidently be shown not to communicate.

  1. Perform CABCDE, control haemorrhage and record pulse, refill, temperature and named motor and sensory nerve findings before any realignment.
  2. Administer the network-approved intravenous prophylactic agent immediately and ideally within one hour, recording the exact dose and time.

Key medicines

Network open-fracture intravenous prophylaxisGive the exact intravenous agent and adult dose specified by the receiving trauma network immediately and ideally within 1 hour of injury; redose and stop at the protocol-defined operative or post-cover point.
Tetanus-containing vaccine and human tetanus immunoglobulinWhen UKHSA wound guidance indicates active immunisation, give 0.5 mL of the appropriate tetanus-containing vaccine intramuscularly; when immunoglobulin is indicated for prevention, give 250 IU intramuscularly, increased to 500 IU if more than 24 hours have elapsed or heavy contamination is present.
Open full textbook →Answer 2 questions
Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom