The justification for antibiotic prophylaxis in operative treatment of hand and wrist bone fractures: a review

Andrzej Żyluk, Jerzy Jabłecki

Abstract


Introduction: Although there is no clear scientific evidence justifying antibiotic prophylaxis in operative treatment of hand and wrist bone fractures, it is commonly used, mostly due to the concern about possible medicolegal problems caused by bone infection after surgery. 
The objective of this study was review of literature on the justification for the use of antibiotic prophylaxis in surgical treatment of hand and wrist fractures. 
Results: For operative treatment of hand fractures 3 studies and 1 systematic review were found. All these articles indicate a lack of scientific evidence to justify the routine administration of antibiotics in these injuries. For operative treatment of distal radial fractures only 1 study was found suggesting that antibiotic prophylaxis does not affect risk of infection. Further literature review showed that redundant antibiotic use may be associated with harmful and adverse effects, as well as with substantial costs. 
Conclusion: Current scientific evidence does not support routine use of antibiotic prophylaxis in operative treatment of hand and wrist bone fractures. Antibiotic administration in these operations has not effect for decreasing infection rate and therefore can be safely avoided.

Keywords


hand fractures; distal radial fractures; operative treatment; complications; antibiotic prophylaxis

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References


Dunn JC, Fares AB, Kusnezov N, Pirela-Cruz M, Gonzalez G, Orr JD, et al. Current evidence regarding routine antibiotic prophylaxis in hand surgery. Hand (N Y) 2018;13(3):259-63.

Negri GA, Andrade JC Jr, Cox MA, de Abreu MF, Appenzeller S, Pagnano RG. Antibiotic prophylaxis and the incidence of surgical site infections in elective clean soft tissue surgery of the hand and upper limb: a systematic review and meta-analysis. J Orthop Trauma 2024;25(1):4.

Bäcker HC, Freibott CE, Wilbur D, Tang P, Barth R, Strauch RJ, et al. Prospective analysis of hand infection rates in elective soft tissue procedures of the hand: the role of preoperative antibiotics. Hand (N Y) 2021;16(1):81-5.

Kistler JM, Munn M, McEntee R, Ilyas AM. Antibiotic prophylaxis in clean hand surgery: a prospective cohort analysis of major and minor complications. J Hand Surg Glob Online 2023;5(4):421-5.

Bykowski MR, Sivak WN, Cray J, Buterbaugh G, Imbriglia JE, Lee WP. Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8,850 cases. J Hand Surg Am 2011;36(11):1741-7.

Shapiro LM, Zhuang T, Li K, Kamal RN. The use of preoperative antibiotics in elective soft-tissue procedures in the hand: a critical analysis review. JBJS Rev 2019;7(8):e6.

Lidauer K, Helenius I, Pääkkönen M. Antibiotic prophylaxis in surgery for closed fracture of the hand. Hand Surg Rehabil 2024;101753. doi: 10.1016/j.hansur.2024.101753.

Aydin N, Uraloglu M, Burhanoglu AD, Sensoz O. A prospective trial on the use of antibiotics in hand surgery. Plast Reconstr Surg 2010;126(5):1617-23.

Hsu LP, Schwartz EG, Kalainov DM, Chen F, Makowiec RL. Complications of K-wire fixation in procedures involving the hand and wrist. J Hand Surg Am 2011;36(4):610-6.

Moriarty TF, Metsemakers WJ, Morgenstern M, Hofstee MI, Vallejo Diaz A, Cassat JE, et al. Fracture-related infection. Nat Rev Dis Primers 2022;8(1):67.

Subramanian P, Kantharuban S, Shilston S, Pearce OJ. Complications of Kirschner-wire fixation in distal radius fractures. Tech Hand Up Extrem Surg 2012;16(3):120-3.

Feldman G, Orbach H, Rozen N, Rubin G. Usefulness of prophylactic antibiotics in preventing infection after internal fixation of closed hand fractures. Hand Surg Rehabil 2021;40(2):167-70.

Gillis JA, Lalonde J, Alagar D, Azzi A, Lalonde DH. K-wire fixation of closed hand fractures outside the main operating room does not increase infections. Plast Reconstr Surg Glob Open 2022;10(11):e4679.

Abul A, Karam M, Al-Shammari S, Giannoudis P, Pandit H, Nisar S. Peri-operative antibiotic prophylaxis in K-wire fixation: a systematic review and meta-analysis. Indian J Orthop 2023;57(7):1000-7.

Tulipan JE, Ilyas AM. Open fractures of the hand: review of pathogenesis and introduction of a new classification system. Hand Clin 2018;34(1):1-7.

Metcalfe D, Aquilina AL, Hedley HM. Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J Hand Surg Eur 2016;41(4):423-30.

Ridley TJ, Freking W, Erickson LO, Ward CM. Incidence of treatment for infection of buried versus exposed Kirschner wires in phalangeal, metacarpal, and distal radial fractures. J Hand Surg Am 2017;42(7):525-31.

Lakshmanan P, Dixit V, Reed MR, Sher JL. Infection rate of percutaneous Kirschner wire fixation for distal radius fractures. J Orthop Surg (Hong Kong) 2010;8(1):85-6.

Sandrowski K, Edelman D, Rivlin M, Jones C, Wang M, Gallant G, et al. A prospective evaluation of adverse reactions to single-dose intravenous antibiotic prophylaxis during outpatient hand surgery. Hand (N Y) 2020;15(1):41-4.

Wachtel N, Meyer E, Volkmer E, Knie E, Lukas B, Giunta R, et al. Efficacy of perioperative antibiotic prophylaxis in elective soft-tissue only wrist arthroscopy. Bone Jt Open 2023;4(4):219-25.

Tacconelli E, De Angelis G, Cataldo MA, Pozzi E, Cauda R. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother 2008;61(1):26-38.

Johnson SP, Zhong L, Chung KC, Waljee JF. Perioperative antibiotics for clean hand surgery: a national study. J Hand Surg Am 2018;43(5):407-16




DOI: https://doi.org/10.21164/pomjlifesci.1085

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