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Do Prophylactic Antibiotics Decrease Risk of Infection in Closed Percutaneous Pinning of Pediatric Hand Fractures?
Christine A Ho1,2,3, Sonia Chaudhry4, Hilton P Gottschalk5
1University of Texas Southwestern Medical Center.
Insights
Pediatric hand fracture surgery (CRPP) showed a lower infection risk with prophylactic antibiotics. Antibiotics reduced superficial infections from 2.01% to 0.2% in this study.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Infectious Disease Prevention
Background:
- Established infection rates for pediatric hand closed reduction percutaneous pinning (CRPP) are limited.
- Adult hand CRPP infection rates range from 7% to 16%, contrasting with a reported 2% in a small pediatric cohort.
Purpose of the Study:
- To establish baseline infection rates for pediatric hand CRPP.
- To compare infection rates between patients receiving prophylactic antibiotics (ABX) and those not receiving them (NABX).
Main Methods:
- Retrospective analysis of 734 pediatric patients undergoing CRPP for closed finger/hand fractures across 6 institutions.
- Comparison of infection rates between ABX and NABX groups using appropriate statistical tests (t-test, Mann-Whitney, χ2, Fisher exact).
Main Results:
- Overall superficial infection rate was 0.8% (6/734).
- The ABX group had a significantly lower infection rate (0.2%) compared to the NABX group (2.01%) (P<0.05).
- Demographics and medical history were similar; however, surgical preparation, immobilization, and procedural times differed between groups.
Conclusions:
- Pediatric hand CRPP is associated with a higher risk of superficial infection in patients not receiving preoperative prophylactic antibiotics.
- The overall infection rate in this large pediatric cohort was comparable to existing literature, but prophylactic antibiotics demonstrated a significant benefit.
Background:
Infection rate after pediatric hand CRPP has been reported to be 2% in a small cohort, while infection rate after adult hand CRPP ranges from 7% to 16%. We are unaware of other established baseline rates of infection for this common pediatric surgery.
Methods:
This is a retrospective study of 734 pediatric patients treated at 6 pediatric institutions who underwent closed reduction percutaneous pinning (CRPP) for a closed finger/hand fracture. The primary goal was to establish infection rates in this patient population, with a secondary objective of comparing infection rates between patients who received preoperative prophylactic antibiotics (ABX) and those who did not receive preoperative prophylactic antibiotics (NABX). Numerical variables were compared with the t test and the Mann-Whitney test; categorical variables were compared with the χ2 test or the Fisher exact test.
Results:
There were 485 patients in the ABX cohort and 249 patients in the NABX cohort. This was a site-randomized study, with 97% (242/249) of NABX from 2 institutions. Patient demographics and medical history were similar between the ABX and NABX groups (P>0.05). The incidence of superficial infection was 0.8% (6/734), with an incidence of 0.2% (1 case) in the ABX cohort and 2.01% (5 cases) in the NABX cohort (P<0.05). Statistically significant differences were found between cohorts with regard to type of surgical preparation, type of immobilization, splitting of postoperative cast in OR, total number of pins used, fluoroscopy time, and time from CRPP to pin removal (P<0.05). No statistical difference was found in complications using the Clavien-Dindo classification.
Conclusion:
In this large cohort, CRPP of pediatric hand fractures had a higher risk of superficial infection if patients did not receive preoperative prophylactic antibiotics, but the rate of infection was similar to existing studies of this patient population.
Levels Of Evidence:
Level III-therapeutic case-control.
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