Overview of Antibiotic Prophylaxis in Orthopaedic and Cardiac Procedures.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors have no known conflicts of interest to disclose. 12. J Am Acad Orthop Surg. 2019 Apr 1;27(7):e301-e310. doi: 10.5435/JAAOS-D-17-00676. Gunshot Wounds to the Upper Extremity. Omid R(1), Stone MA, Zalavras CG, Marecek GS. Author information: (1)From the Department of Orthopaedic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA. Upper extremity gunshot wounds result in notable morbidity for the orthopaedic trauma patient. Critical neurovascular structures are particularly at risk. The fractures are often comminuted and may be associated with a variable degree of soft-tissue injury. The literature lacks consensus regarding antibiotic selection and duration, and indications for surgical débridement. Bullets and/or bullet fragments should be removed in cases of plumbism, intra-articular location, nerve impingement, location within a vessel, and location in a subcutaneous position within the hand and/or wrist. Gunshot fractures generally do not follow common fracture patterns seen in blunt injuries, and the complexity of certain gunshot fractures can often be a challenge for the treating orthopaedic surgeon. Common plate and screw constructs may not adequately stabilize these injuries, and innovative fixation techniques may be required. The treatment for bone defects varies by location and severity of injury, and typically requires staged treatment. Nerve injuries after gunshot wounds are common, but spontaneous nerve recovery is expected in most cases. DOI: 10.5435/JAAOS-D-17-00676