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Do Prophylactic Antibiotics Decrease Infection Risk in Closed Reduction and Pinning of Pediatric Hand Fractures?
Margaret Wang, BSc, Manjot Singh, B.S., Michael Kuharski, BA, Alan H Daniels, MD, Reena Bhatt, MD; Vinay Rao, MD
Brown University, Providence, RI
Purpose: The role for prophylactic antibiotics in closed reduction percutaneous pinning (CRPP) following pediatric hand fractures is not well-established nor standardized in practice. As antibiotic administration is not without risks, we sought to investigate the role of pre-operative antibiotics in decreasing the incidence of post-operative infection in the pediatric population.
Methods: PearlDiver, a large national insurance claims database, was queried to identify pediatric patients 18 years and under undergoing CRPP following hand and wrist fractures or dislocations. Patients with a history of cancer or any other surgery within one year of CRPP were excluded from the study. Patients who received pre-operative antibiotics (administration of intravenous cefazolin, vancomycin, or clindamycin the same day as surgery) and patients who did not were propensity-score matched for age, sex, geographical region and past medical history including diabetes and obesity. Primary outcome was post-operative surgical site infection (SSI) diagnosed within 90 days of the initial surgery. Outcome measures were compared across groups using Chi-square statistical analysis.
Results: A total of 34,752 patients were included in the study. There were 17,376 patients in each arm of the study. The overall incidence of post-operative SSI in the cohort was 0.88% (N = 306). There was no significant difference in infection rate between the pre-operative antibiotics group (N = 162, 0.93%) and control group (N = 144, 0.83
%, P = 0.33). The rate of osteomyelitis specifically was 0.06% for the overall cohort (N = 21). The incidence of osteomyelitis was statistically significantly lower in the pre-operative antibiotics group (n = 5, 0.03%) compared to the control group (n = 0.09%, OR 0.31, 95% CI 0.11 - 0.85, P = 0.003).
Conclusion: Post-operative infection following CRPP for pediatric hand fractures is uncommon, and osteomyelitis is rare. Prophylactic antibiotics may not decrease the overall rate of post-operative infection but may decrease the rate of osteomyelitis.
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