Do Prophylactic Antibiotics Decrease Risk of Infection in Closed Percutaneous Pinning of Pediatric Hand Fractures?

BACKGROUND

Infection rate after pediatric hand CRPP has been reported to be 2% in a small cohort, while infection rate after adult hand CRPP ranges from 7% to 16%. We are unaware of other established baseline rates of infection for this common pediatric surgery.

METHODS

This is a retrospective study of 734 pediatric patients treated at 6 pediatric institutions who underwent closed reduction percutaneous pinning (CRPP) for a closed finger/hand fracture. The primary goal was to establish infection rates in this patient population, with a secondary objective of comparing infection rates between patients who received preoperative prophylactic antibiotics (ABX) and those who did not receive preoperative prophylactic antibiotics (NABX). Numerical variables were compared with the t test and the Mann-Whitney test; categorical variables were compared with the χ2 test or the Fisher exact test.

RESULTS

There were 485 patients in the ABX cohort and 249 patients in the NABX cohort. This was a site-randomized study, with 97% (242/249) of NABX from 2 institutions. Patient demographics and medical history were similar between the ABX and NABX groups (P>0.05). The incidence of superficial infection was 0.8% (6/734), with an incidence of 0.2% (1 case) in the ABX cohort and 2.01% (5 cases) in the NABX cohort (P<0.05). Statistically significant differences were found between cohorts with regard to type of surgical preparation, type of immobilization, splitting of postoperative cast in OR, total number of pins used, fluoroscopy time, and time from CRPP to pin removal (P<0.05). No statistical difference was found in complications using the Clavien-Dindo classification.

CONCLUSION

In this large cohort, CRPP of pediatric hand fractures had a higher risk of superficial infection if patients did not receive preoperative prophylactic antibiotics, but the rate of infection was similar to existing studies of this patient population.

LEVELS OF EVIDENCE: Level III-therapeutic case-control.