Open Fracture Antibiotic and Tetanus Guideline

NOTE: Open femur fractures are considered Gustilo III regardless of the size of the soft tissue injury. 

Gustilo open fracture Classification
Gustilo Grade	Definition
I	Clean wound <1 cm in length
II	Wound > 1 cm without extensive soft-tissue damage, flaps, avulsions
III	Extensive soft-tissue laceration, damage, or loss or an open segmental fracture.
IIIA	Adequate periosteal coverage despite the extensive soft-tissue laceration or damage
IIIB	Extensive soft-tissue loss and periosteal stripping and bone damage. Usually associated with massive contamination. Will often need further soft-tissue coverage procedure (i.e. free or rotational flap)
IIIC	Arterial injury requiring repair, irrespective of degree of soft-tissue injury.

History of Tetanus Vaccination	Last Dose	Wound Type	Tetanus Booster	Tetanus Immunoglobulin
< 3 doses or uncertain		Clean, minor wounds	Yes	No
< 3 doses or uncertain		All other wounds	Yes	Yes
3 or more doses	< 5 years	All wounds	No	No
3 or more doses	5-10 years	Clean, minor wounds	No	No
3 or more doses	5-10 years	All other wounds	Yes	No
3 or more doses	>10 years	All wounds	Yes	No

Reviewed 3-1-24 Moghadamian, Kleumper, Brooke Watts, C Reynolds, A Bernard