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Introduction: Evidence regarding the efficacy of prophylactic antibiotics to prevent infection in the setting of pediatric tuft fractures has been inconclusive. However, the few studies published to date suggest there may not be any additional benefit in infection prevention with antibiotic prophylaxis, which is consistent with adult studies. This study was conducted to determine if current treatment practices reflect the available evidence and whether there was any difference in reported and observed treatment practices among respondents or at our tertiary care pediatric facility.

Materials and Methods: A survey to assess current treatment practices among physicians was distributed to members of the American Association for Hand Surgery. Respondents were asked to indicate their treatment preference in various injury scenarios of increasing severity. Incomplete responses were excluded. In addition, a retrospective chart review was conducted of patients treated at our facility from 2010-2016 for comparison. Patient details were collected from the electronic medical record with IRB approval. Data were analyzed using descriptive statistics and chi squared analysis of proportions with 95% confidence intervals.

Results: There were a total of 104 survey respondents with 89% having fellowship training in hand surgery. Overall, responses followed a predictable trend of increasing antibiotic prophylaxis with increasing injury severity. However, those who indicated their specialty as Plastic Surgery were significantly less likely to prescribe antibiotic prophylaxis in the proposed scenarios compared to those who indicated their specialty as either Hand Surgery or Orthopaedic Surgery. Additionally, observations from our retrospective sample (n=218 injuries treated) demonstrated significantly higher rates of antibiotic prophylaxis in mild injuries compared to treatment recommendations of survey respondents.





Conclusions: The available literature does not conclusively support nor refute the use of prophylactic antibiotics for pediatric tuft and nail bed injuries. Plastic surgeons are more likely to treat these injuries without prophylactic antibiotics in these scenarios, especially with more severe injury, but response sizes were limited. Additionally, when compared to these reported national trends, prophylactic antibiotics were prescribed more frequently at our institution. Further studies are planned to better evaluate under which conditions prophylactic antibiotics are indicated in pediatric tuft fractures and nail bed injuries.