Open fractures: antibiotic for type III injury: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Orthopaedics · Open fractures: antibiotic for type III injury

Sample item

A farmer has an open tibial fracture with a 14 cm contaminated wound and extensive soft tissue loss. Which antibiotic regimen is conventionally given in addition to tetanus prophylaxis?

AA first-generation cephalosporin with an aminoglycoside such as gentamicinBIntravenous metronidazole aloneCOral amoxicillin alone for 5 daysDA single dose of oral ciprofloxacin only

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. A first-generation cephalosporin with an aminoglycoside such as gentamicin

Open fractures need early intravenous antibiotics, ideally within the first hour. Type I and II injuries are covered by a first-generation cephalosporin such as cefazolin, and type III injuries add gram-negative cover with an aminoglycoside. Antibiotics supplement, and never replace, urgent surgical debridement.

Option by option

A. A first-generation cephalosporin with an aminoglycoside such as gentamicin (correct)
Correct. Cefazolin gives gram-positive cover and gentamicin adds gram-negative cover for a type III wound.
B. Intravenous metronidazole alone
Metronidazole covers anaerobes only and misses staphylococci and gram-negative rods.
C. Oral amoxicillin alone for 5 days
Oral amoxicillin alone gives inadequate cover and is not given for 5 days as a regimen for severe open fractures.
D. A single dose of oral ciprofloxacin only
A single oral dose is not adequate prophylaxis for a heavily contaminated wound.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, A first-generation cephalosporin with an aminoglycoside such as gentamicin. Open fractures need early intravenous antibiotics, ideally within the first hour.

Why is "Intravenous metronidazole alone" not the answer?

Metronidazole covers anaerobes only and misses staphylococci and gram-negative rods.

Why is "Oral amoxicillin alone for 5 days" not the answer?

Oral amoxicillin alone gives inadequate cover and is not given for 5 days as a regimen for severe open fractures.

Why is "A single dose of oral ciprofloxacin only" not the answer?

A single oral dose is not adequate prophylaxis for a heavily contaminated wound.

What concept does this question test?

It tests Open fractures: antibiotic for type III injury in Orthopaedics. Type I and II injuries are covered by a first-generation cephalosporin such as cefazolin, and type III injuries add gram-negative cover with an aminoglycoside. Antibiotics supplement, and never replace, urgent surgical debridement.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Open fractures: antibiotic for type III injury?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.