How to Treat a Shotgun Blast Injury

A 32 year old man sustains a shotgun blast injury to his hand 14 hours prior to presentation. He presents with the severely wounded hand from a high velocity gunshot injury and multiple metacarpal fractures. The on-call orthopedic resident is consulted immediately after he arrives. This is incorrect as length of hospital stay has not been associated with multidisciplinary training for the management of open fractures. Time to antibiotic administration has also been demonstrated to have significant effect on decreasing infection risk.