Infection not significantly reduced with prophylactic antibiotics in open phalanx fracture

Study Type: Meta-analysis/Systematic Review
OE Level of Evidence: 1
Journal Level of Evidence: 1
Four randomized controlled trials were included in this systematic review and meta-analysis to evaluate the effect of prophylatic antibiotic administration in the case of open distal phalanx fracture. Data on superficial infection rate and incidence of osteomyelitis development were pooled. Results on infection Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: None disclosed
Why was this study needed now?
Current practices for management of open fractures have been developed from observation and investigative trials of long-bone fractures. Nonetheless, there is ongoing debate on whether or not these guidelines aptly apply to cases of small-bone open fracture, such as that in the hand. Given that a large proportion of hand injuries are open distal phalanx fractures, investigation of the role of prophylactic antibiotic administration in these injuries seemed prudent.
What was the principal research question?
In patients with open distal phalanx fracture, does prophylatic antibiotic administration significantly reduce infection rate?
Data Source: MEDLINE, EMBASE, AMED, The Cochrane Library, and Open Grey were searched for relevant articles published up to October 2014. Additionally, conference proceedings from the British Orthopaedic Association, the British Trauma Society, the Orthopaedic Trauma Association, and the European Federation of National Associations for Orthopaedics and Traumatology were search from presentations between March 2002 and December 2014. Lastly, trial registries, -,, and - were searched for ongoing trials.
Index Terms: Search strategy included keyword terms of ("distal phalanx" OR "terminal phalanx" OR "tuft fracture" or "fingertip") AND ("open" OR "compound" AND "fracture").
Study Selection: Eligibility criteria included: enrollment of patients with an open distal phalanx fracture; compared the administration of antibiotic to either placebo or no intervention; and reported the incidence of superficial infection of the development osteomyelitis. Study selection was performed independently by two reviewers. A total of four randomized controlled trials, with data sampled from 353 open fractures, were selected for final inclusion.
Data Extraction: A standardized extraction table was used for data extraction. In the case of insufficient data in the published reports, attempt was made to contact corresponding authors for additional data.
Data Synthesis: Statistical analysis was performed using Stata software (Stata 13.0). Odds ratios (OR) were calculated for dichotomous data, both under fixed-effects and random-effects models. Heterogeneity was assessed using the I-squared statistic (I^2). Unit of analysis was defined as individual fractures, as opposed number of patients.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.