Infection rates not affected by antibiotic prophylaxis in supracondylar humerus fractures
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LAS VEGAS — Routine use of prophylactic antibiotics for pediatric supracondylar humerus fractures treated with closed reduction and percutaneous K-wire pinning may not affect infection rates or fracture healing, according to presented data.
“We recommend against the routine use of antibiotic prophylaxis in [closed reduction and percutaneous K-wire pinning] CRPP surgery for pediatric supracondylar humerus fractures. We feel our study can be used to develop guidelines to help surgeons determine whether antibiotics are right for their patient or not,” Sumit Gupta, MD, MPH, FAAOS, said at the American Academy of Orthopaedic Surgeons Annual Meeting, here.
Gupta and colleagues conducted a prospective double-blinded, randomized controlled trial of 165 patients with supracondylar humerus fractures who were treated at a single level trauma center a 5-year period. Patients with open fractures, current or recent infection, currently taking antibiotics or have a history of immunosuppression were excluded. All patients underwent closed reduction and percutaneous K-wire pinning and casting, and pins were removed 3 to 6 weeks postoperatively depending on age and surgeon preference.
Patients were randomized into two groups. Group 1 was 84 patients who received one dose of 25 mg/kg cefazolin up to 1 g. Patients with cefazolin allergy received one dose of 10 mg/kg clindamycin up to 600mg/kg. The 81 patients in group 2 received a placebo of 10 mL normal saline. Three patients were excluded from final analysis because they were converted to open reduction, and two patients were not followed up.
Gupta and colleagues found two infections – one in each group. The only deep infection that required a return to the OR was in a patient in the antibiotic group. said there was no difference seen between the groups in erythema at pin sites, discharge and fever. Researchers found no significant difference in bony healing rates between groups. Patients in the control group had more tenderness at fracture sites pin removal, however no further follow-up was needed for the tenderness.
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Gupta S, et al. Paper #322. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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