Evaluation of Role of Antibiotic-Impregnated Beads in Compound Fractures (Compound Grade 2 and Grade 3)
Journal Title: Journal of Bone and Joint Diseases - Year 2018, Vol 0, Issue 0
Abstract
Background: Open fractures are still a burden on orthopedic surgeons. The main goals in managing such injuries include infection prevention, fracture stabilization, skin and soft-tissue coverage, and adjacent joint mobility, function enhancement, and fracture union. This study was designed to evaluate the efficacy of antibiotic-impregnated beads with conventional intravenous antibiotics in the treatment of open fractures. Materials and Methods: In our study, 34 patients with 49 compound fractures were reviewed. Three fractures were Grade 1 hence excluded, 24 # as Grade 2, and 22 # as Grade 3 by Gustilo classication. There were two groups: Groups A and B. In Group A, we had a total of 24 open fractures (14 compound Grade 2 and 10 compound Grade 3). In Group B, a total of 22 open fractures (10 compound Grade 2 and 12 compound Grade 3). Group A was managed with antibiotic (vancomycin and gentamicin)-impregnated bead chains and systemic antibiotic (ceriaxone and tobramycin) prophylaxis. Group B received systemic antibiotic prophylaxis (ceriaxone, tobramycin, metrogyl, and amikacin). Results: A total of 26 compound fractures (56.52%) (16 compound fractures [66.6%] from Group A and 10 compound fractures [45.45%] from Group B) were closed primarily or early, 43.47% (33.33% from Group A and 54.54% from Group B underwent delayed closure). Six compound grade fractures (13.04%) developed an acute wound infection (1 open fracture [4%] from Group A and 5 open fractures [22.7%] from Group B). Those fractures (26 fractures out of 46, i.e., 16 compound # from Group A and 10 compound # from Group B) that did not develop any infection were closed at mean time of 7.9 days; those that developed an infection or unsatisfactory wound condition closed at mean time of 18.6 days. The difference of mean time for the closure of wound in different groups was statistically significant (P < 0.001). Conclusions: This study shows that antibiotic beads may be useful in preventing infection in open fractures
Authors and Affiliations
C P Pal C P Pal, R K Shakunt R K Shakunt, Brijesh Sharma, K S Dinkar K S Dinkar, Aditya Prakash, Yajuvendra Kumar
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