Single-dose antibiotic prophylaxis in osteosynthesis for hip fractures. A clinical multicentre study in Finland.

BACKGROUND AND AIMS: The use of antibiotic prophylaxis in open reduction and osteosynthesis of closed hip fractures is still controversial. The aim of this study was to demonstrate the effect of antibiotic prophylaxis in osteosynthesis of these fractures. MATERIAL AND METHODS: A total of 224 patients operated on between November 1994 and February 1998 in six hospitals by internal fixation for a fresh hip fracture were prospectively and randomly allocated to either a ceftriaxone antibiotic prophylaxis or no prophylaxis group and followed for one year. RESULTS: Within 6 weeks after the operation, 2.6% wound infections were recorded in the antibiotic group and 4.7% in the control group. Two (1.9%) of the five infections in the control group were deep infections (both sensitive to ceftriaxone). There were no statistically significant differences between the infection rates in both groups. However, when analyzing all complications recorded within 6 weeks, significantly more complications were found in the control group (p < 0.01). In the multivariate analysis the most important factor predicting postoperative complications was the lack of antibiotic prophylaxis. CONCLUSION: In this study the antibiotic prophylaxis group had significantly less postoperative complications than the control group within 6 weeks after the operation.

Metallic or absorbable implants for ankle fractures: a comparative study of infections in 3,111 cases.

Absorbable fracture fixation has been in clinical use since 1984. Our study compares the infection rates and some infection parameters between metallic (2073 patients) and absorbable fracture fixation devices (1012 patients) in displaced ankle fractures. The infection rate associated with metallic fixation was 4.1%, compared with 3.2% absorbable fixation (p 0.3). The patients who had a wound infection were older when metallic fixation was used (p 0.01). They also had a bi- or trimalleolar fracture more often than did patients treated with absorbable fracture fixation, but this difference did not have a significant effect on the wound infection rate (p 0.2). The infections were mostly caused by microorganisms of the Staphylococcus species. Deep infections were equally common with both fixation methods (0.4%), but there was some variation in the bacterial spectrum.

Wound infections associated with absorbable or metallic devices used in the fixation of fractures, arthrodeses and osteotomies.

Totally absorbable internal fixation devices have been used in a total of 2114 operations for the treatment of fractures, arthrodeses and osteotomies at our department between November 1984 and December 1992. The infection rate was 3,5%, for pure polyglycolide (PGA) implants 4% and for pure polylactide (PLLA) implants 0,7%. When the fixation with absorbable implants was compared to that of metallic implants in another series the infection rates were 4% and 9%, respectively. This difference was due to technical reasons. Sinus formation due to a foreign body reaction was observed in 2,5% of 2114 cases and was subsequently infected in 20%.