Open Fractures · trauma

A 28-year-old arrives 40 minutes after a motorcycle crash with a type IIIA open tibial shaft fracture. The wound is contaminated with road debris. Vital signs are stable. After a trauma survey, what is the first orthopedic-specific order that most changes infection risk?

• AHold antibiotics until intraoperative cultures return
• BGive systemic antibiotics now, then plan urgent irrigation and debridement
• CApply a spanning external fixator in the trauma bay before any antibiotics
• DSchedule definitive nailing first, then start antibiotics in the PACU