Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis

Metcalfe, David; Aquilina, Alex; Hedley, Helen

doi:10.1177/1753193415601055

Cited by 33 publications

(19 citation statements)

References 22 publications

(44 reference statements)

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“…First, the provision of preoperative antibiotics (either as a short oral course in the days leading up to emergency surgery or as a one-off dose at the time of anaesthesia induction) was not associated with a reduced risk of SSI in either the elective or emergency surgery models. This is in keeping with the wider literature on perioperative antibiotic use in upper limb surgery 34 , 35 , 44 , 45 which demonstrates no benefit from (pre- or postoperative) antibiotics in patients who have no clinical features of infection and who are destined for surgery. As we approach an existential crisis surrounding antimicrobial resistance 25 , surgeons could consider exercising greater restraint and prescribe fewer antibiotics until definitive evidence from high-quality multicentre randomised trials is generated.…”

Section: Discussionsupporting

confidence: 79%

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR): an international multicentre prospective cohort study

et al. 2021

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Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary.

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Section: Discussionsupporting

confidence: 79%

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR): an international multicentre prospective cohort study

et al. 2021

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“…Although favorable results can be achieved with surgical treatment of closed distal phalangeal fractures, complications such as infection, reduction loss, nonunion, or complex regional pain syndrome can occur in selected patients. [23][24][25] However, none of these complications were observed in any of the patients in this study.…”

Section: Discussioncontrasting

confidence: 48%

Distal falanks kırığı olan erişkin hastalarda kapalı redüksiyon ve perkutan Kirschner teli uygulaması ile açık redüksiyon internal fiksasyon uygulaması sonuçları karşılaştırılması

Acar¹,

Bezirgan²,

Armangil³

2021

Sakarya Medical Journal

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Objective We aimed to compare functional and radiological results of closed reduction with percutaneous Kirschner wire (K-wire) fixation versus open reduction with internal fixation in adult patients with distal phalangeal fractures. Materials and MethodsA total of 13 patients (8 males, 5 females) who were operated for distal phalangeal fractures in our center between February 2019 and December 2020 were retrospectively reviewed.The patients were divided into two groups according to the type of surgery:Group 1 (n=6) undergoing closed reduction with percutaneous K-wire fixation and Group 2 (n=7) undergoing open reduction with internal fixation.Functional results were evaluated using the total active range of motion (TAROM) scale.Demographic and clinical characteristics and operative data were recorded.The time to return to work was assessed between the groups. ResultsThe median age was 37 (range, 24 to 51) years and the median follow-up was 13 (range, 10 to 18) months.According to the TAROM scale, excellent and good results were achieved in 11 and two patients, respectively.The median time to complete union was 4 (range, 3 to 6) weeks.There was no significant difference in the functional and radiological results between the groups.However, the median time to return to work was significantly shorter in Group 2 (p=0.03).None of the patients had postoperative complications such as infection, reduction loss, nonunion or complex regional pain syndrome. Conclusion Although both treatment methods yield satisfactory and comparable functional and radiological results in patients with distal phalangeal fractures, open reduction with internal fixation is significantly associated with a shorter time to return to work. Keywords Distal phalangeal fracture; adult; Kirschner wire; open reduction; internal fixation Öz Amaç Çalışmada; kapalı redüksiyon ve perkutan Kirschner teli (K teli) ile açık redüksiyon internal fiksasyon uyguladığımız distal falanks kırığı olan erişkin hastaların fonksiyonel ve radyolojik sonuçlarının değerlendirilmesi amaçlandı. Gereç ve Yöntemle Şubat 2019 ile Aralık 2020 tarihleri arasında 13 hasta (8 erkek, 5 kadın), iki ayrı gruba ayrılarak retrospektif olarak değerlendirildi. 1. gruba kapalı redüksiyon ve perkutan K teli ( 6 hasta) ve 2. gruba açık redüksiyon internal fiksasyon (7 hasta) uygulandı. Fonksiyonel sonuçlar total aktif eklem hareket açıklığı (TAEHA) skalasına göre değerlendirildi. Analiz Statistical Package for the Social Sciences (SPSS) ve Student t-testine göre yapıldı. p<0.05 olması anlamlı kabul edildi.Gruplarda işe dönüş zamanı karşılaştırıldı. Bulgular Hastaların ortalama yaşı 37 (24-51) ve ortalama takip süresi 13 (10-18) aydı. TAEHA skalasına göre 11 hasta mükemmel ve 2 hastada iyi sonuç elde edildi. Ortalama 4 (3-6) hafta içinde tüm hastalarda tam kaynama görüldü. Radyolojik ve fonksiyonel açıdan anlamlı fark saptanmadı. İşe dönüş zamanı açısından 2. grup anlamlı bulundu (p=0.03). Enfeksiyon, redüksiyon kaybı, kaynamama ve kompleks bölgesel ağrı sendromu gibi komplikasyonlar görülmed...

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“…Most isolated metacarpal fractures can be treated using nonoperative interventions. Relevant cadaveric studies have reported that every 2 mm of shortening would result in approximately 7° of extensor lag [ 16 , 17 ]. Because most phalangeal joints hyperextend by approximately 20°, the metacarpophalangeal joints can still remain neutral even when the metacarpus is shortened 5 to 6 mm.…”

Section: Discussionmentioning

confidence: 99%

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

Chiu

Hsu

et al. 2021

J Orthop Surg Res

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Background Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side. Objective The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture. Materials and methods Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test. Results The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm). Conclusion According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

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Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis

Cited by 33 publications

References 22 publications

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR): an international multicentre prospective cohort study

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR): an international multicentre prospective cohort study

Distal falanks kırığı olan erişkin hastalarda kapalı redüksiyon ve perkutan Kirschner teli uygulaması ile açık redüksiyon internal fiksasyon uygulaması sonuçları karşılaştırılması

Bone plate fixation ability on the dorsal and lateral sides of a metacarpal shaft transverse fracture

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