tients were managed as follows: debridement and copious irrigation, primary closure for Type I and I1 fractures and secondary closure for Type I11 fractures, no primary internal fixation except in the presence of associated vascular injuries, cultures of all wounds, and oxacillin-ampicillin before surgery and for three days postoperatively. In 158 of the patients in the prospective study the initial wound cultures revealed bacterial growth in 70.3 per cent and the infection rate was 2.5 per cent. Sensitivity studies suggested that cephalosporin is currently the prophylactic antibiotic of choice. For the Type I11 open fractures (severe soft-tissue injury, segmental fracture, or traumatic amputation), the infection rates were 44 per cent in the retrospective study and 9 per cent in the prospective study. Prevention of wound sepsis remains the prime objective in the management of open fractures. The reported infection rates in these fractures, which range from 3 to 25 per cent, are a challenge to every surgeon who treats them 6-%l0,14.15.21.22,26~
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