Pediatric patients presenting with open fractures will be screened for eligibility at the
time of presentation. Informed consent form discussion will take place within 8 hours of
the patient's presentation, or before their second dose of antibiotics would be due (if
randomized to group 2 or 3).
Upon arrival to the ED with an open fracture (grade I or II), the patient is assessed and
care is initiated based on patient presentation. Patients are given an IV for medication
administration and receive the first dose of antibiotics (cefazolin) as soon as possible.
This is standard of care.
Treatment of the fracture includes irrigation with saline (at least 1 liter depending on
wound size). The fracture then needs to be stabilized and wound closed. Patients are
taken to the trauma room typically within 8 hours of presentation for sedation and closed
reduction of the fracture. These practices are standard of care.
If the patient and guardian consent to the study, the patient will be randomized to one
of three study arms:
A) one dose of IV cefazolin B) 24 hours IV cefazolin (3 doses Q8hrs) C) 24 hours IV
cefazolin (3 doses Q8hrs) plus 5 days oral cephalexin.
Patients in group A will have no further antibiotic administration, assuming they
received their first (and only) dose as soon as possible upon arrival. Patients in groups
B and C will need to receive their second doses of IV cefazolin 8 hours after
administration of the first dose. This is why we plan to consent the patients/guardians
within 8 hours of presentation.
Aside from antibiotic administration, all other treatment will be standard of care.
Patients will undergo closed reduction and any other medical management deemed necessary.
Prior to discharge, participants will be educated on how to identify symptoms of
infection. It is standard of care to discuss this during discharge education.
Frequency of follow up will be determined by standard of care treatment plan for age and
fracture type. This is at the discretion of the physician. Typical follow up is at 1 week
then 1 or 2 week intervals for up to 8-12 weeks. Study team members will check the
patient's medical record for indication of infection or adverse events at each follow-up
visit. If no follow up is reported after three months, study staff will conduct a phone
interview to collect this data.