Efficacy of Topical Antibiotic Powder Application in the Emergency Department on Reducing Deep Fracture-Related Infection in Type III Open Lower Extremity Fractures: A Multicenter Study.

OBJECTIVES

Deep fracture-related infections (FRIs) are a common complication of type III open lower extremity fractures, resulting in notable patient morbidity. The purpose of this study was to determine whether topical application of antibiotic (ABX) powder to type III open lower extremity fracture wounds upon presentation to the emergency department (ED) reduces the rate of FRI.

METHODS

This is a retrospective review of ABX powder application compared with a historical cohort at 4 level 1 trauma centers. Patients with type III open lower extremity fractures from July 1, 2019, to October 1, 2022, who received topical ABX powder (1 g vancomycin and 1.2 g tobramycin) in the ED were compared with patients from a 4-year historical cohort who were treated through the same protocol without topical ABX powder. Outcomes include the development of FRI within 6 months of follow-up. Patient demographics, injury characteristics, and postoperative data were analyzed in addition to FRI.

RESULTS

One hundred fifteen patients received topical ABX powder in the ED and were compared with 135 patients who were treated without topical ABX powder. The rate of FRI in the intervention group was 8 of 115 (6.96%) vs. 22 of 135 (16.30%) in the control cohort ( P = 0.024). Multivariate regression analysis demonstrated higher body mass index as a risk factor for the development of FRI ( P = 0.003). When excluding those with intraoperative ABX powder use, there was still a markedly lower rate of FRI when ED ABX powder was used on regression analysis ( P = 0.048).

CONCLUSION

Antibiotic powder application to type III open fracture wounds in the ED markedly reduces the incidence of FRI in this multicenter study. Further large-scale studies are warranted.

LEVEL OF EVIDENCE: Therapeutic Level III.