Evidence brief
The EAST Practice Management Guidelines Work Group Guidelines for the Management of Open Fractures
Antibiotics should be administered as soon as possible after injury
First-generation cephalosporin for Gustilo I-II; add aminoglycoside for Type III
No evidence supports >24 hours antibiotic duration for Type I-II
Debridement timing: within 6 hours not supported by evidence; within 24 hours reasonable
Tetanus prophylaxis according to immunization status
These guidelines synthesize evidence for open fracture management. The '6-hour rule' for debridement is not evidence-based; quality of debridement matters more than arbitrary timing. Early antibiotics remain critical.
Common examiner trap: '6-hour rule' for debridement. Know this is not evidence-based - quality of debridement more important than timing within 24 hours. Antibiotics: cephalosporin (Types I-II), add aminoglycoside (Type III), add penicillin (farm/contamination).
Hoff WS et al. The Eastern Association for the Surgery of Trauma Practice Management Guidelines for the Management of Open Fractures. 2011 (updated).
Level I
Systematic review of RCTs or high-quality RCT