SS  Vol.2 No.6 , August 2011
The Role of Prophylactic Antibiotics for Percutaneous Procedures in Orthopaedic Surgery
Abstract: Introduction This study investigates the current practice of surgeons in the United Kingdom with regards to their usage of prophylactic antibiotics for percutaneous orthopaedic procedures. Methods An electronic survey of 10 questions was devised and sent to all members of the British Orthopaedic Association. Three hundred and three replies were obtained (172 consultants, 131 trainees). Results Only half the numbers of orthopaedic surgeons would routinely use antibiotics for percutaneous K-wire fixation. Of the other half, 28% would never prescribe antibiotics and 22% would use them in special circumstances only. These ‘special circumstances’ were also not standardised. 92% of those who did prescribe antibiotics would administer single dose only and the majority (90%) would administer them during induction. There was no significant difference between trainees and consultants or between different orthopaedic procedures with regards to whether prophylactic antibiotics were prescribed or not. Discussion This survey highlights the split of opinion amongst practising orthopaedic surgeons as to the necessity or otherwise of antibiotic prophylaxis in percutaneous orthopaedic procedures. There are no reliable guidelines and further work should be carried out to investigate this subject.
Cite this paper: nullA. Gulati, A. Dixit and D. Williamson, "The Role of Prophylactic Antibiotics for Percutaneous Procedures in Orthopaedic Surgery," Surgical Science, Vol. 2 No. 6, 2011, pp. 348-352. doi: 10.4236/ss.2011.26075.

[1]   E. Wong, “Surgical Site Infections,” In: D. G. Mayhall, Ed., Hospital Epidemiology and Infection Control, 2nd Edition, Lippincott, Philadelphia, 1999, pp. 189-210.

[2]   R. Plowman, N. Graves, M. A. S. Griffin, J. A. Roberts, A. V. Swan, B. Cookson, et al., “The Rate and Cost of Hospital-Acquired Infections Occurring in Patients Admitted to Selected Specialties of a District General Hospital in England and the National Burden Imposed,” Journal of Hospital Infection, Vol. 47, No. 3, 2001, pp. 198-209. doi:10.1053/jhin.2000.0881

[3]   L. J. Prokuski, “Selecting an Appropriate Prophylactic Antibiotic Agent; Reduce Surgical Site Infections with Appropriate Prophylactic Antibiotic Use,” American Academy of Orthpaedic Surgeons Bulletin, 2005.

[4]   O. M. Lidwell, R. A. Elson, E. J. Lowbury, W. Whyte, R. Blowers, S. J. Stanley, et al., “Ultraclean Air and Antibiotics for Prevention of Postoperative Infection. A Multicenter Study of 8052 Joint Replacement Operations,” Acta Orthopaedica Scandinavica, Vol. 58, No. 1, 1987, pp. 4-13. doi:10.3109/17453678709146334

[5]   National Institute for Health and Clinical Excellence, “Surgical Site Infection: Prevention and Treatment of Surgical Site Infection,” October 2008.

[6]   Scottish Intercollegiate Guidelines Network, “Antibiotic Prophylaxis in Surgery: A National Clinical Guideline,” Guideline No. 104, July 2008.

[7]   T. Flinkkila, J. Ristiniemi, P. Hyvonen and M. Hama- lainen, “Surgical Treatment of Unstable Fractures of the Distal Clavicle: A Comparative Study of Kirschner Wire and Clavicular Hook Plate Fixation,” Acta Orthopaedica Scandanica, Vol. 73, No.1, 2002, pp. 50-53. doi:10.1080/000164702317281404

[8]   H. Habernek and L. Schmid, “Technique and Results of Modified Percutaneous Bore Wire Osteosynthesis of the Distal Radius,” Unfallchirurg, Vol. 95, No.7, 1992, pp. 339-343.

[9]   D. G. Armstrong, G. R. Pupp and L. B. Harkless, “Our Fixation with Fixation: Are Screws Clinically Superior to External Wires in Distal First Metatarsal Osteotomies?” Journal of Foot and Ankle Surgery, Vol. 36, No. 5, 1997, pp. 353-355. doi:10.1016/S1067-2516(97)80035-X

[10]   L. Karapinar, H. Ozturk, T. Altay and B. Kose, “Closed Reduction and Percutaneous Pinning with Three Kirschner Wires in Children with Type III Displaced Supracondylar Fractures of the Humerus,” Acta Orthopaedica et Traumatologica Turcical, Vol. 39, No. 1, 2005, pp. 23-29.

[11]   P. Devkota, J. A. Khan, B. M. Acharya, N. M. Pradhan, L. P. Mainali, M. Singh, et al., “Outcome of Supracondylar Fractures of the Humerus in Children Treated by Closed Reduction and Percutaneous Pinning,” Journal of Nepal Medical Association, Vol. 47, No. 170, 2008, pp. 66-70.

[12]   J. Battle and K. D. Carmichael, “Incidence of Pin Track Infections in Children’s Fractures Treated with Kirschner Wire Fixation,” Journal of Pediatric Orthopaedics, Vol. 27, No. 2, 2007, pp. 154-157. doi:10.1097/bpo.0b013e3180317a22

[13]   T. Azzopardi, S. Ehrendorfer, T. Coulton and M. Abela, “Unstable Extra-articular Fractures of the Distal Radius: A Prospective, Randomised Study of Immobilisation in a Cast Versus Supplementary Percutaneous Pinning,” British Journal of Bone and Joint Surgery, Vol. 87, No. 6, 2005, pp. 837-840. doi:10.1302/0301-620X.87B6.15608

[14]   A. Rafique, S. Ghani, M. Sadiq and I. A. Siddiqui, “Kirschner Wire Pin Tract Infection Rates between Percutaneous and Buried Wires in Treating Metacarpal and Phalangeal Fractures,” Journal of College of Physicians and Surgeons Pakistan, Vol. 16, No. 8, 2006, pp. 518-520.

[15]   G. Schmidmaier, M. Lucke, B. Wildemann, N. P. Haas and M. Raschke, “Prophylaxis and Treatment of Implant-Related Infections by Antibiotic-Coated Implants: A Review,” Injury, Vol. 37, Supplement 2, 2006, pp. S105-S112. doi:10.1016/j.injury.2006.04.016

[16]   D. G. Hargreaves, S. J. Drew and R. Eckersley, “Kirschner Wire Pin Tract Infection Rates: A Randomized Controlled Trial between Percutaneous and Buried Wires,” British Journal of Hand Surgery, Vol. 29, No. 4, 2004, pp. 374-376. doi:10.1016/j.jhsb.2004.03.003

[17]   A. Lethaby, J. Temple and J. Santy, “Pin Site Care for Preventing Infections Associated with External Bone Fixators and Pins,” Cochrane Database of Systemic Review, No. 4, 2008, p. CD004551.

[18]   M. M. Patterson, “Multicenter Pin Care Study,” Orthopaedic Nursing, Vol. 24, No. 5, 2005, pp. 349-360. doi:10.1097/00006416-200509000-00011