Which medications are commonly included in open fracture management?

• A. Cefazolin (Ancef) alone
• B. Cefazolin (Ancef), tetanus toxoid, Toradol, opioids
• C. Amoxicillin and clavulanate
• D. Vancomycin and corticosteroids

Answer: (B)

Open fracture care aims to prevent infection while keeping the patient comfortable and protected against tetanus. The best approach starts with a antibiotic that covers the common skin flora at the wound site—cefazolin supplies coverage against Staphylococcus and streptococci, which are the usual culprits in open fractures. Because tetanus can be a risk with dirty, open wounds, tetanus toxoid vaccination is given if the patient’s immunization status isn’t up to date. Pain control is essential for healing and patient comfort, so including an NSAID like ketorolac (Toradol) for analgesia together with opioid analgesics for more severe pain helps manage the injury effectively. This combination addresses infection prevention, tetanus protection, and pain management, which is why it’s the best choice. Other options either omit one of these important components or use therapies not routinely indicated for open fracture management.