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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Efficacy of Pre-Operative Antibiotic Therapy in Pediatric Supracondylar Fractures Treated with Closed Reduction and Percutaneous K-Wire Fixation
Etasha M Bhatt, MD1; Bradley M Kruckeberg, BA1; Taylor J Ridley, MD1; Deborah S Quanbeck, MD2; Alison N Schiffern, MD2
1University of Minnesota, Minneapolis, MN; 2Gillette Children's Specialty Healthcare, St.

Paul, MN

Background: Controversy exists surrounding antibiotic use in the setting of supracondylar humerus (SCH) fractures treated with closed reduction and percutaneous k-wire fixation (CRPP). While the reported rate of infection in the literature is low, surgeons frequently administer pre-operative antibiotics. The purpose of this study was to retrospectively review antibiotic use and infection rates in children with SCH fractures treated with CRPP. It was hypothesized that antibiotic administration will not affect infection rates following this procedure.

Methods: Following IRB approval, a retrospective review was conducted of 899 patients with SCH fractures treated with CRPP at one institution between 2006 and 2015. Patient demographics, antibiotic administration and follow-up data were reviewed in 223 patients were reviewed for provisional analysis and reporting.

Results: Of 223 patients, 132 patients received antibiotics preoperatively and 91 patients did not. The infection rate in the group that received pre-operative antibiotics was 1.5% (n=2) and 3.3% (n=3) in the group that did not receive pre-operative antibiotics. The overall infection rate was 2.2%. In review of the 5 infections treated with oral antibiotics, 2 of the 5 patients' casts were removed early by family (n=1) or were removed early due to water exposure (n=1). Signs of infection for those five patients included, fever (n=1), edema (n=2) inflammation at pin site (n=4) and clear drainage (n=1). All of the infections were superficial and successfully treated with oral antibiotics only.

Discussion/Conclusion: Preliminary results of SCH fractures treated with CRPP at one institution demonstrated that perioperative antibiotic administration had no effect on the rate of infection (p=0.40). This data is consistent with the current literature. Despite these trends, many surgeons continue to administer prophylactic antibiotics for CRPP of SCH fractures. Even within this institution, there is inconsistent administration of perioperative antibiotics among surgeons. Continued review of remaining patient cohort is needed for improved study power and analysis.


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