Medication Summary
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.
Analgesics
Class Summary
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.
Acetaminophen and codeine (Tylenol #3)
Drug combination indicated for treatment of mild to moderately severe pain.
Hydrocodone bitartrate and acetaminophen (Vicodin ES)
Drug combination indicated for relief of moderately severe to severe pain.
Antibiotics
Class Summary
Therapy must cover all likely pathogens in this clinical setting. Antibiotic combinations may be required for broad coverage in grossly contaminated wounds.
Cefazolin (Ancef, Kefzol, Zolicef)
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.
Gentamicin (Gentacidin, Garamycin)
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.
Vancomycin (Vancocin)
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.
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Assessment of the hand for rotational deformities of the fingers or metacarpals is essential, as such deformities, if untreated, may result in significant functional compromise. With fingers flexed at the metacarpophalangeal and proximal interphalangeal joints and extended at the distal interphalangeal joints, fingers should all point toward the scaphoid bone (see image).
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Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.
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Displaced fourth and fifth metacarpal fractures, anteroposterior view.
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Fourth and fifth metacarpal fractures, oblique view.
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Metacarpophalangeal ligaments.
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Metacarpophalangeal musculoskeletal structure.
