The use of parenterally administered antibiotics preoperatively and postoperatively in orthopedic procedures has not proved significantly effective in preventing postoperative infection. This present controlled study (466 patients in a 28-month period) investigated the effect of local neomycin sulfate irrigation of orthopedic surgical wounds before closure on postoperative wound healing and complications. By the technique of irrigation and the doses of neomycin sulfate instilled into the wound (100 cc of 0.1% solution), there was no evidence that the antibiotic significantly altered the rate of infection or wound healing in osseous or soft tissue orthopedic wounds with or without metal implants.In the past 25 years the possibility of surgery, free from infection, has become a more and more attainable goal. Since the introduction of antibi¬ otics, the orthopedist, faced with wound infection and osteomyelitis, has reached for this goal as Tan¬ talus reached for his fruit tree. The closer the goal seems, the farther away it becomes.The most promising approach was postoperative prophylactic antibiotic therapy. Barnes1 in 1959 studied 1,007 consecutive surgical cases. Every other month, all postsurgical patients were given a combination of penicillin benzathine V and dihydrostreptomycin while in the recovery room. An "infective complication" rate of 9.8% was found without antibiotics and a rate of 11.4% with anti¬ biotics. Infective complications included pneumonia and phlebitis as well as wound infection. The rate of wound infection was 2.7% without antibiotics and 8.9% with antibiotics. Not only was there no decrease in the infection rate, but 76% of the infec¬ tions in the antibiotic-treated group were resistant to penicillin and streptomycin. Only 22% of the in¬ fections in the nontreated group were resistant. Several similar studies in the 1950's failed to show any beneficial effect of prophylactic antibi¬ otic therapy.In 1957 Tachdjian and Compere2 reviewed the records of 3,000 consecutive "clean" orthopedic op¬ erations. Major infection occurred in 1.89% of 1,900 operations when antibiotics were used prophylactically. In 1,100 operations without prophy¬ lactic antibiotics, 0.74% of the wounds became infected. When antibiotics were given prophylactically, most of the infections were caused by resis¬ tant organisms.Another approach to the prophylaxis of wound infection has been the irrigation of wounds with various antibiotic and antiseptic solutions. Single¬ ton3 studied the effect of several solutions on experi¬ mentally induced infection in guinea pigs. By smear¬ ing wounds with a human feces homogenate, an infection rate of 83% was produced. Irrigations with saline, sulfonamides oxychlorosene (Chlorpactin), and iodine all reduced the infection rate sig¬ nificantly. Neomycin alone, reduced the infection rate to a level comparable with the clean wound. Irrigation of a wound with neomycin also reduced the infection rate in distant wounds of the same guinea pig. Singleton's study made neomycin seem the ideal anti...

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