Do peri-operative prophylactic antibiotics reduce pin-site infection after K-wire application in closed fractures? An international prospective cohort study.

BACKGROUND AND PURPOSE: The role of peri-operative prophylactic antibiotics in preventing pin-site infection after percutaneous K-wire fixation of closed fractures is unclear, and guidance does not address this procedure. This study evaluated whether prophylaxis reduces infection risk in this setting.

METHODS

International, multicentre, prospective cohort study across 30 hospitals in three countries (United Kingdom, Spain, Greece) from December 2023 to October 2024, including patients with distal radius or supracondylar elbow fractures managed by percutaneous K-wire fixation. Antibiotic administration was at the treating surgeon's discretion, so the comparison was observational. The primary outcome was surgical site infection (SSI) up to two weeks after K-wire removal, with a pre-specified analysis stratified by fracture type.

RESULTS

Of 397 submitted cases, 394 were analysed and SSI outcome data were available for 384 (97.5%). Prophylaxis was the dominant practice, given in 342/394 (86.8%). Nine SSIs occurred (2.3%), with similar incidence in the antibiotic and no-antibiotic groups (8/333 [2.4%] vs 1/51 [2.0%]; risk difference +0.4 percentage points, 95% CI -3.7 to +4.6; p = 1.000). Findings were unchanged when stratified by fracture type and after Mantel-Haenszel adjustment. Eight of nine infections involved soft tissue only; no septic arthritis occurred.

CONCLUSIONS

Despite prophylaxis being given to the large majority of patients, no reduction in SSI was observed. The confidence interval remains compatible with a clinically important effect in either direction, so a type II error cannot be excluded. These data do not support universal routine prophylaxis, but an adequately powered non-inferiority randomised trial is required before practice changes.