Antibiotic prophylaxis and other factors influencing infection risk reduction in hand and forearm fracture surgery: a narrative review.

Abstract

Surgical site infection is a serious complication of fracture surgery that often requires antibiotic treatment, implant removal, and wound debridement. Antibiotic prophylaxis is one of the measures taken to reduce the risk of surgical site infection. Other factors influencing the risk of infection include leaving the ends of the K-wires protruding through the skin vs. buried under the skin, operating under full sterility vs. field sterility in the operating room, or the burden of comorbidities. The purpose of this study was to review the current literature on antibiotic prophylaxis and other factors that influence the risk of infection during surgery for hand and distal radial fractures. We also reviewed the literature on potential adverse effects and costs of antibiotic prophylaxis. Results. Three studies and one systematic review were identified for the operative treatment of closed hand and distal radius fractures, none of which supported the routine use of antibiotic prophylaxis. For leaving the ends of K-wires exposed versus burying them under the skin, two articles were found. One reported an increased risk of surgical site infection when K-wires are left exposed, and the other reported that it does not matter. Three studies reported harmful and adverse effects of unnecessary use of antibiotic prophylaxis. Two studies reported an increased risk of surgical site infection in patients with comorbidities, compromised immunity, smoking, and alcohol use. The routine use of antibiotic prophylaxis generates significant costs that can be avoided if it is used as recommended by evidence-based medicine. Conclusion. The authors believe that this review may have many beneficial effects for patients and the health care system, such as: preventing bacterial resistance, increasing the efficacy of antibiotics in true infections, reducing the risk of adverse reactions, and reducing health care costs.