Is antibiotic prophylaxis necessary for emergency joint or flexor tendon sheath hand injuries?

Emergency hand wounds involving joint or flexor tendon sheath exposure are considered at risk for postoperative infection. Intraoperative antibiotic prophylaxis is frequently prescribed in this setting, although its benefit remains controversial. This study aimed to evaluate the impact of intraoperative antibiotic prophylaxis on postoperative infection rates in this population.

A retrospective monocentric cohort study included adult patients operated on for clean emergency hand wounds with joint or flexor tendon sheath involvement between December 2023 and February 2025. Patients were divided into two groups according to intraoperative antibiotic prophylaxis administration: antibiotic group (A) and no antibiotic group (NA). The primary outcome was the occurrence of surgical site infection within 30 days postoperatively. Demographic data, injury characteristics and surgical delay were collected and compared between groups.

A total of 149 patients were included (median age: 33 years; 71% male). Seventy-three patients received intraoperative antibiotic prophylaxis and 76 did not. The overall infection rate was 2.0%. Infection occurred in 2.7% of patients in group A and 1.3% in group NA, with no statistically significant difference between groups (p = 0.60). No difference was observed regarding demographic characteristics, injury patterns or surgical delay between groups, except for male predominance in group A.

Intraoperative antibiotic prophylaxis did not reduce postoperative infection rates in emergency hand wounds with joint or flexor tendon sheath involvement. These results suggest that routine antibiotic prophylaxis may not be necessary in clean cases and support the need for larger prospective multicenter studies to establish evidence-based guidelines.