Journal of orthopaedic trauma
September 23, 2026 · via Europe PMC
Ceftriaxone versus cefazolin plus gentamicin for antibiotic prophylaxis in Gustilo-Anderson type III open lower extremity fractures.
Foster C, Richardson L, Pegg B, Garg V, Kye B, Lu X, Young P.
AI summary — for doctors, generated from the abstract only
Ceftriaxone alone had similar infection and complication rates to cefazolin plus gentamicin for prophylaxis in type III open lower extremity fractures.
What was studied
A retrospective single-center cohort of 307 patients with Gustilo-Anderson type III open lower extremity fractures receiving cefazolin plus gentamicin (229) or ceftriaxone (78).
Key findings
- FRI was 18.3% vs 12.8% unadjusted (P=.343)
- Adjusted FRI HR was 1.26 (not significant)
- No difference in acute kidney injury
- Type IIIB/C injuries (HR 3.05) and time to antibiotics over 60 minutes (HR 2.56) increased FRI risk
Clinical relevance
Suggests ceftriaxone monotherapy may be a reasonable alternative, but unequal groups and follow-up warrant caution.
Who should care
Limitations
Retrospective design with unequal group sizes, injury severity, and follow-up.
Injury severity and antibiotic timing mattered more than regimen choice for open fracture infection.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
To compare fracture related infection (FRI) rates and outcomes between ceftriaxone (CTX) and cefazolin plus gentamicin (C+G) for antibiotic prophylaxis in Gustilo-Anderson (GA) type III open lower extremity fractures.
Methods
Design: Retrospective cohort study.
Setting
Single, academic level one trauma center.
Patient selection criteria
Included were patients age 18-89 years with GA type III open lower extremity fractures (AO/OTA 32,33,41,42,43,4F3, 44) from 2013 to 2024 with at least 6 weeks follow-up.
Outcome measurements and comparisons
The primary outcome was FRI. Secondary outcomes included acute kidney injury (AKI), nonunion, and other complications. Cox proportional hazards models and multivariable logistic regression adjusted for confounding variables.
Results
Of 3,334 lower extremity fractures reviewed, 307 met inclusion criteria: 229 C+G and 78 CTX. Mean age (40.4 [range 18-88] vs 41.2 [range 18-81] years, p=0.7) and sex (75.1% vs 64.1% male, p=0.084) were similar between the C+G and CTX cohorts. Mean follow-up was 23.8 months (C+G) and 14.0 months (CTX) (P=0.002). The C+G cohort had more tibial shaft fractures (34.1% vs 19.2%, P=0.014) and type IIIB injuries (19.7% vs 7.7%, P=0.014). On unadjusted analysis, there was no significant difference in FRI (18.3% vs 12.8%, P=0.343) or AKI (11.4% vs 12.8%, P=0.728) or organisms cultured. After adjusting for GA type, fracture location, time to debridement and time to antibiotics there remained no significant difference in FRI (HR=1.26, 95% CI: 0.59-2.68, P=0.545), AKI (OR=1.51, 95% CI: 0.62-3.49, P=0.349) or other complications between antibiotic regimens. Tibial shaft fractures trended towards higher risk of FRI compared to femur fractures (HR=2.15, P=0.052). GA type IIIB/C fractures (HR=3.05, p60min (HR=2.56, p=0.003) were associated with higher odds of FRI.
Conclusions
Ceftriaxone monotherapy demonstrated similar rate of FRI and complications compared to cefazolin plus gentamicin for Gustilo-Anderson type III open lower extremity fractures. Severity of the open fracture and time to antibiotics were independently associated with higher infection risk regardless of antibiotic regimen.
Level of evidence
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
DOI
10.1097/bot.0000000000003286
PMID
42775682
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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