gms | German Medical Science

Objectives/Interrogation: Prophylactic antibiotic treatment after orthopedic surgery is a controversial issue. The present study aimed to compare the efficacy of antibiotic therapy with that of antibiotic prophylaxis in the treatment of Swanson type I open fractures of the hand.

Methods: The prospective study involved 179 patients presenting Swanson type I open fractures of the hand, all of whom were submitted to conventional surgical treatment in a trauma reference hospital during 16 months. Group 1 patients (n = 92) were hospitalized for 3 days and received intravenous antibiotic therapy (four doses of cefalotin per day; 140 mg/kg/day). After release, patients received four oral doses of cefalexin per day (30 mg/kg/day) for 7 days. Group 2 (n = 87) patients remained in hospital for only a short period (less than 24 hours) during which they received intravenous antibiotic prophylaxis (three doses of cefalotin) every 4 h. No oral medication was prescribed after release. Both groups were followed-up each week for 1 month after the injury. Standard statistical methods were applied to evaluate frequency distributions, the Fisher exact test was employed to establish the statistical significance of frequency association and differences were considered statistically significant for p inferior to 0.05.

Results and Conclusions: The study population comprised more males (90.5%) than females. Crushing was the most frequent cause of injury (29.6%). Seventy-five patients (41.9%) presented lesions (180 in total) of soft tissues associated with the fractures, with a significant predominance (p < 0.001) of lesions of the extensor tendons. The infection rate among the overall population was 2.2% (two cases in each group) with no significant differences between the groups.

Antibiotic prophylaxis is as effective as antibiotic therapy for complementing surgical treatment of Swanson type I open fractures of the hand to avoid early infections, which may contribute to shorter hospitalization periods.