Northwell Health Orthopaedic Institute
Management of Grade 1 Open Distal Radius Fractures

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* 1. What type of residency program did you complete?

Orthopedic surgery

Plastic surgery

General surgery

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* 2. Did you train in a fellowship program?

Upper Extremity

Trauma

Sports

Oncology

Joint Reconstruction

Spine

Pediatrics

Foot and Ankle

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* 3. What setting do you predominantly practice in?

Urban, academic

Suburban, academic

Urban, community

Suburban, community

Rural, community

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* 4. Excluding antibiotic administration and debridement considerations, what is a reasonable definitive treatment protocol for a displaced, Gustillo-Anderson grade 1 open distal radius fracture? Select all applicable responses.

Closed reduction alone if alignment remains acceptable on follow up

Closed reduction followed by emergent (less than 8 hours) open reduction and internal fixation

Closed reduction followed by urgent (less than 48 hours) open reduction and internal fixation

Closed reduction followed by delayed (greater than 48 hours) open reduction and internal fixation

Closed reduction followed by closed reduction and percutaneous pinning

Closed reduction followed by external fixation

Closed reduction followed by operative management if loss of acceptable reduction

Open reduction and internal fixation alone

External fixation alone

Other (please specify)

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* 5. What criteria do you use to determine your treatment regimen of grade 1 open distal radius fractures? Select all applicable responses.

Level of contamination

Mechanism of injury

Fracture pattern

Fracture displacement on follow up

Age of patient

Comorbidities of patient

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* 6. At the time of injury, how would you address the patient’s tetanus immunization status?

Do not address tetanus status

Provide tetanus prophylaxis/treatment, regardless of patient’s immunization status

Provide tetanus prophylaxis/treatment as recommended by current Center for Disease Control Guidelines

Other (please specify)

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* 7. Do you prescribe antibiotics at the time of injury?

Yes, IV antibiotics only

Yes, IV antibiotics followed by oral antibiotics

Yes, oral antibiotics only

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* 8. Assuming a clean-contaminated grade 1 open distal radius fracture and that the patient had no allergies, what antibiotics would you prescribe?

Cephalosporin

Cephalosporin with aminoglycoside

Penicillin in addition to another antibiotic

Other (please specify)

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* 9. Regardless of surgical intervention, if prescribing PO or IV antibiotics for a grade 1 open distal radius fractures, what is the duration of antibiotic treatment?

PO antibiotics only, 24 hours

PO antibiotics only, greater than 24 hours

IV antibiotics followed by PO antibiotics, 24 hours combined

IV antibiotics followed by PO antibiotics, greater than 24 hours combined

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* 10. Where do you first irrigate and debride the wound? Would you close the wound?

Do not irrigate and debride, do not close

Do not irrigate and debride, close primarily in the ED

Do not irrigate and debride, close primarily in the OR

In the ED and close primarily

In the ED but do not close

In the OR and close primarily

In the OR but do not close

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* 11. If surgically treating a grade 1 open distal radius fracture with internal fixation, would you primarily close the injury wound or leave open?

Close wound

Do not close wound

Incorporate wound into approach incision and close

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* 12. What is the realistic time at which you would perform a debridement in the operating room?

Not applicable

Within 6 hours

Within 24 hours

Within 72 hours

Within 1 week

Greater than 1 week

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* 13. Does your surgical fixation choice differ between a grade 1 open distal radius fracture and a closed distal radius fracture?

Yes

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* 14. In relation to the administration of systemic antibiotics, what role do you believe local antibiotics have in a grade 1 open distal radius fractures?

Local antibiotics have no role

Local antibiotics have an adjuvant role

Local antibiotics may be used instead of systemic antibiotics

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* 15. If you perform surgical fixation of the fracture, what is your post-operative antibiotic protocol?

No antibiotics

Perioperative antibiotics only

IV antibiotics for 24 hours

IV antibiotics for greater than 24 hours

Oral antibiotic course only

IV followed by oral antibiotics

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* 16. If a patient with a grade 1 open distal radius fracture presented greater than 72 hours after injury with repeat x-rays demonstrating stable and acceptable alignment, would you treat the fracture nonoperatively?

Yes

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* 17. If an elderly patient with insignificant medical comorbidities and good functional status presented with a displaced grade 1 open distal radius fracture, would the presence of an open fracture necessitate operative irrigation and debridement?

Yes

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* 18. Is concern for litigation a major factor in your treatment algorithm of Grade 1 open distal radius fracture?

Yes