For open fractures, what is the initial management step?

• A. Delayed debridement after several days
• B. Oral antibiotics only
• C. Immediate debridement and IV antibiotics after admission
• D. Prompt surgical debridement and IV broad-spectrum antibiotics

Answer: (D)

Open fractures carry a high risk of infection because contaminated soil and debris are driven into a wound that communicates with bone and soft tissue. The key move is to physically remove dead tissue and contaminants as soon as possible while starting antibiotics that cover a broad range of organisms. Debridement reduces the bacterial load and eliminates nonviable tissue that bacteria thrive on, and IV broad-spectrum antibiotics help penetrate tissues and address both gram-positive and gram-negative organisms. This combination minimizes the chance of infection, osteomyelitis, and poor healing. Delaying debridement or relying on oral antibiotics alone fails to control the contaminated wound, making infection far more likely.