In an open fracture the clock on infection starts at injury, and the single most effective step the receiving team controls is early antibiotics. Give them within an hour of the patient reaching hospital, and do not wait for theatre to start them.
Cover with the regimen local guidance specifies, usually a first-generation cephalosporin, escalating for heavy contamination as advised. Alongside this, photograph the wound once, cover it with a saline-soaked dressing, align and splint the limb, and confirm tetanus status.
Debridement timing can follow the urgency of the injury, but the antibiotic should not wait for it. Documenting the time given keeps this reliable across handovers.
- Give antibiotics within one hour of arrival for any open fracture; do not delay for theatre.
- Use the locally specified regimen and escalate cover for heavily contaminated wounds.
- Photograph the wound once, cover with a saline-soaked dressing, and splint the limb.
- Confirm tetanus status and document the time antibiotics were given.
Why it matters
Early antibiotics are the step most strongly tied to lower infection in open fractures, yet they are often delayed until the operation.
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