[Antibiotic prophylaxis in cases of closed fractures and prostheses]

Antibiotic prophylaxis can be administered systemically or locally when bone cement is used for the implantation of prosthesis. In closed fracture surgery parenteral broad spectrum antibiotics are advised with 1 dose (in case of a long halflife) or for at least 12 hours when an antibiotic with a shorter half life is used. With such a prophylaxis a reduction of the infection rate to about 3% can be achieved, and also an important reduction of the postoperative nosocomial infections. Such a prophylaxis is highly cost effective. In primary prosthesis implantation, a 24 hours prophylaxis is needed. The use of antibiotic loaded bone cement, used as prophylaxis in primary prostheses is effective too, and this kind of cement should be used in combination with systemic antibiotics. In prosthesis an infection rate of 0.2% should be achieved.