Evaluation of a New Strategy for Protocolized Antibiotic Care for Severe Open Fractures: SEXTANT

Inclusion Criteria:

1. Injury meeting at least one of the following criteria:

• Gustilo type III tibia (OTA 41 plateau, OTA 42 shaft and OTA 43 pilon)requiring a second procedure for final debridement and definitive coverage /closure following the index stabilization

• Gustilo type IIIB ankle fractures (OTA 44)

• Gustilo type IIIB calcaneus fractures (OTA 82)

• Gustilo type IIIB talus fractures (OTA 81)

• Traumatic "zone-of-injury" trans-tibial amputations requiring DPC, and/or flapcoverage

2. Ages 18 - 64 years inclusive

3. Patients may have risk factors for infection including diabetes, immunosuppressionfrom steroids or other medications, HIV, or other infections.

4. Patients may have a traumatic brain injury.

5. Patients may have other fractures including spine, upper extremity fractures,contralateral lower extremity injuries, ipsilateral pelvis, hip, femur or footinjuries.

6. Patients may be treated initially at an outside institution prior to transfer to thestudy institution, as long as the definitive wound closure or coverage was notperformed prior to entrance into the study.

7. Patients with bilateral injuries that meet inclusion criteria may be included, butonly the limb rated as "more severe" by the treating surgeon will be enrolled in thestudy.

8. Patients may have co-existing non-tibial or hindfoot infection, with or withoutantibiotic treatment.

9. Patients may be definitively stabilized using any method (nail, plate, ex fix orcast).

10. Patients may have a fasciotomy.

Exclusion Criteria:

1. Patient in current therapy for a wound, implant or fracture site infection relatedto the study site.

2. Patient likely to have difficulty maintaining follow-up, including:

• Diagnosis of a severe psychiatric condition

• Intellectually challenged without adequate family support

• Resides outside of the hospital's catchment area

• Planning to follow-up at another medical center

• Being a prisoner

• Not having a means of contact (address, cell phone, home phone, e-mail)