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Effect of Antibiotic Prophylaxis on Infection Rates in Pediatric Supracondylar Humerus Fractures Treated with Closed
Sumit K Gupta1, Ennio Rizzo Esposito, Rachel Phillips
1From the Department of Orthopaedic Surgery, University of Missouri, Columbia, MO.
Insights
Prophylactic antibiotics did not reduce infection risk in pediatric patients undergoing closed reduction and percutaneous Kirschner wire pinning for supracondylar humerus fractures. This finding supports current guidelines suggesting no routine antibiotic use for this procedure.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Infectious Disease Prevention
Background:
- Supracondylar humerus fractures (SCHFs) are the most common elbow fracture in children.
- Closed reduction and percutaneous Kirschner wire pinning (CRPP) is standard for displaced SCHFs.
- Current evidence on the benefit of prophylactic antibiotics for CRPP is limited and conflicting.
Purpose of the Study:
- To evaluate the efficacy of single-dose prophylactic antibiotics in reducing infection rates in pediatric patients undergoing CRPP for displaced SCHFs.
- To address the variability in antibiotic usage based on surgeon preference and institutional policy.
Main Methods:
- A double-blinded, randomized controlled trial was conducted with pediatric patients with displaced SCHFs.
- Patients were randomized to receive either a single dose of prophylactic antibiotics (cefazolin or clindamycin) or a placebo.
- All patients underwent CRPP, casting, and subsequent pin removal, with infection surveillance.
Main Results:
- No statistically significant difference in the overall infection rate was observed between the antibiotic prophylaxis group (1.2%) and the placebo group (1.3%).
- Specific infection outcomes, including purulent drainage, septic arthritis, and osteomyelitis, were similar between the two groups.
- There was no difference in the need for additional antibiotics or further surgical intervention between the groups.
Conclusions:
- Single-dose antibiotic prophylaxis does not reduce the risk of infection in pediatric patients undergoing CRPP for displaced SCHFs.
- The findings suggest that routine prophylactic antibiotic use may not be necessary for this patient population and procedure.
- This study provides Level I evidence to guide clinical practice regarding antibiotic use in pediatric SCHF treatment.
Background:
Supracondylar humerus fractures (SCHFs) are the most common elbow fracture in the pediatric population. In the case of displaced fractures, closed reduction and percutaneous Kirschner wire pinning (CRPP) is commonly performed. Infection rates are between 0 and 7%; however, retrospective studies have shown no benefit of preoperative antibiotics. There continues to be notable variability in antibiotic usage based on surgeon preference and local institutional policy. We conducted a double-blinded, randomized controlled trial to evaluate whether antibiotic prophylaxis reduces the risk of infection in pediatric SCHF patients treated with CRPP.
Methods:
Pediatric patients with displaced SCHF who presented to a pediatric hospital were enrolled and randomized into two groups. Group I received one dose of prophylactic antibiotics (25 mg/kg cefazolin IV up to 1g or clindamycin 10 mg/kg up to 600 mg/kg IV in the case of cefazolin allergy). Group II received placebo (10-mL prefilled syringe of normal saline). All patients underwent CRPP and casting followed by pin removal 3 to 6 weeks after the initial procedure. The presence of pin-site infection, erythema, drainage, septic arthritis, and osteomyelitis was recorded.
Results:
One hundred sixty patients were enrolled in the study. Eighty-two patients were randomized to receive antibiotics, and 78 patients were randomized to placebo. No difference was seen in the rate of infection between the treatment groups (1.2% in the antibiotic group versus 1.3% in the placebo group; P = 1.00). Presence of purulent drainage (0.0% versus 1.3%; P = 0.49), septic arthritis (0.0% versus 0.0%; P = 1.00), and osteomyelitis (1.2% versus 0.0%; P = 1.00) was similar in both groups. No difference in the need for additional antibiotics (1.2% versus 1.3%; P = 1.00) or additional surgery (1.2% versus 0.0%; P = 1.00) was found between groups.
Discussion:
The use of antibiotic prophylaxis did not affect the risk of infection in pediatric patients who underwent CRPP for displaced SCHF.
Clinical Trial Registration:
ClinicalTrials.gov: NCT03261830.
Level Of Evidence:
Therapeutic Level I.
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