Role of topical antibiotics in hip surgery. A prospective randomised study

The effectiveness of topical antibiotics has been shown well enough in vitro to justify strong consideration of their use in orthopaedic procedures. We carried out a randomised prospective trial to study the role of topical chloramphenicol ointment application on postoperative wounds following surgeries for hip fractures.

One hundred cases with fracture neck of femur were enrolled in the study. They were randomized into two treatment groups: one group had chloramphenicol ointment applied at the surgical site at the end of procedure and 3rd day postoperatively, while the control group did not. The wound was checked on the 3rd, 6th, 12th and 30th days postoperatively, by a tissue viability nurse on the guidelines issued by the Scottish Centre for Infection and Environmental Health (SCIEH).

We had 12 cases with superficial infection of which 8 belonged to control group. The risk of developing wound infection, however, was not significant with and without the use of chloramphenicol ointment (relative risk 0.430, 95% confidence interval (CI) 0.120-1.544). Using multivariate analysis, no association was found between wound infection and age, gender, type of fracture or type of surgical procedure. Smoking was found to be the only factor significantly associated with infection, with the relative risk for current smokers compared with former/non-smokers being 7.29 (95% CI 1.62-32.67).

Awareness is needed amongst the general public about the ill effects of smoking. There was reduction in the incidence of wound infection with the use of topical antibiotic ointment. However, this was not statistically significant to recommend its use in routine practice. A larger study should provide useful information on the role of topical antibiotic and its effect on postoperative wound infection.