SOFT-TISSUE INJURIES322 Musculoskeletal and Soft-tissue Emergencies
(c) superficial wound obviously contaminated by soil, dust or
horse manure (especially if topical disinfection is delayed
more than 4 h)
(d) wounds containing foreign bodies especially wood
splinters
(e) compound fracture
(f) bite
(g) wounds complicated by pyogenic infections
(h) reimplantation of an avulsed tooth.
(ii) Clean minor wound
Any wound that is clean, incised or superficial, i.e. does not fulfil any
of the criteria above of the tetanus-prone wound.
5 Tetanus vaccines and immunoglobulin
(i) Adsorbed tetanus toxoid in Australia is combined with
diphtheria (ADT) and is suitable for use age ≥8 years. Prior to
this age, combinations with diphtheria and pertussis as well
as other agents for protection against polio, hepatitis B and
Haemophilus influenzae type b are recommended
(a) administer by deep i.m. injection 0.5 mL into upper arm or
anterolateral thigh
(b) contraindications to tetanus vaccine include prior
anaphylaxis to tetanus toxoid or any of its components
(extremely rare).
(ii) Active tetanus toxoid immunization in the UK from 2006 is
recommended given combined with diphtheria, pertussis,
Haemophilus influenzae type B (HiB) and inactivated polio
vaccines up to age 10 years, then combined with diphtheria and
inactivated polio thereafter.
(iii) Confer additional passive protection immediately by
administering tetanus immunoglobulin (TIG) when indicated
(see Table 10.1):
(a) give 250 IU by deep i.m. injection, or 500 IU if the wound is
>24 h old, at a site distant from the tetanus toxoid combined
vaccines.MANAGEMENT
1 Tetanus immunization schedule (see Table 10.1).
(i) Clean minor wound
(a) patients fully immunized and with boosters up to date
require no immunization
(b) give patients with an incomplete tetanus immunization
schedule a tetanus toxoid combined-vaccine booster, and
arrange completion of a full tetanus course with the GP