Hand Fracture Medication
- Author: Erik D Schraga, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Control pain with commonly prescribed medications. Acetaminophen with codeine or hydrocodone usually suffices.
Prescribe antibiotics for open fractures, usually a cephalosporin (ie, cefazolin sodium) with broad-spectrum coverage added for grossly contaminated wounds.
Pain control is essential to quality patient care. It ensures patient comfort and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained fractures.
Drug combination indicated for treatment of mild to moderately severe pain.
Drug combination indicated for relief of moderately severe to severe pain.
Therapy must cover all likely pathogens in this clinical setting. Antibiotic combinations may be required for broad coverage in grossly contaminated wounds.
First-generation, semisynthetic cephalosporin that, by binding to 1 or more penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial replication. Primarily active against skin flora, including Staphylococcus aureus. Typically used alone for skin and skin-structure coverage.
Total daily dosages are same for IV/IM routes.
Aminoglycoside antibiotic used for gram-negative bacterial coverage. Commonly used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Used in conjunction with ampicillin or vancomycin for prophylaxis in patients with open fractures.
Potent antibiotic directed against gram-positive organisms and active against enterococcal species. Useful in treatment of septicemia and skin-structure infections.
Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients with open fractures.
May need to adjust dose in patients diagnosed with renal impairment.
Hammert WC. Treatment of nonunion and malunion following hand fractures. Clin Plast Surg. 2011 Oct. 38 (4):683-95. [Medline].
[Guideline] Rubin DA, Daffner RH, Weissman BN, Bennett DL, Blebea JS, Jacobson JA, et al. ACR Appropriateness Criteria acute hand and wrist trauma. [online publication]. Reston (VA): American College of Radiology (ACR). 2008. [Full Text].
Capo JT, Hall M, Nourbakhsh A, Tan V, Henry P. Initial management of open hand fractures in an emergency department. Am J Orthop (Belle Mead NJ). 2011 Dec. 40 (12):E243-8. [Medline].
Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. 2008 Oct. 16(10):586-95. [Medline].
Ozçelik D, Toplu G, Unveren T, Kaçagan F, Senyuva CG. Long-term objective results of proximal phalanx fracture treatment. Ulus Travma Acil Cerrahi Derg. 2011 May. 17(3):253-60. [Medline].
Ben-Amotz O, Sammer DM. Practical Management of Metacarpal Fractures. Plast Reconstr Surg. 2015 Sep. 136 (3):370e-9e. [Medline].
Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y). 2014 Mar. 9 (1):16-23. [Medline].
Pavic R, Malovic M. Operative treatment of Bennett's fracture. Coll Antropol. 2013 Mar. 37(1):169-74. [Medline].
Houshian S, Jing SS. Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator: a report of 16 cases. Hand Surg. 2013. 18(1):73-8. [Medline].
Gajendran VK, Gajendran VK, Malone KJ. Management of complications with hand fractures. Hand Clin. 2015 May. 31 (2):165-77. [Medline].
American Society for Surgery of the Hand, Idler RS, Mantktelow RT. The Hand Examination and Diagnosis. New York: Churchill Livingstone; 1990. 13-73.
Antosia R, Lyn E. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998.
Harwood-Nuss A, Wolfson A. Hand injuries. Clinical Practice of Emergency Medicine. 4th ed. 2005. 1062-1065.
Rosen P, Doris P. Musculoskeletal trauma. Diagnostic Radiology in Emergency Medicine. 1992. 178-182.
Ruiz E, Cicero JJ. Hand injuries and infections. Emergency Management of Skeletal Injuries. St. Louis, MO: Mosby-Year Book; 1990. 339-59.
Simon RR, Koenigsknecht SJ. Fractures of the hand. Emergency Orthopedics. 4th ed. New York: McGraw-Hill; 2001. 97-133.
Stewart C, Winograd S. Hand injuries: a step by step approach for clinical evaluation and definitive management. Emerg Med Rep. 1997. 18:223-234.
Tintinalli JE, Ruiz E, Krome RL. Injuries to the hand and digits. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw Hill; 2004. 2004: 1665-1674.