REAMED NAILING OF OPEN TIBIAL FRACTURES - DOES THE ANTIBIOTIC BEAD POUCH REDUCE THE DEEP INFECTION-RATE

Eighty-one open tibial fractures were treated by reamed intramedullary nailing. There were 38 type II, 23 type IIIa and 20 type IIIb injurie s. At the end of the nailing procedure the first 26 fractures (15 type II, five type IIIa, and six type IIIb) had antibiotic prophylaxis and delayed closure of the open wound, The subsequent 55 fractures (23 ty pe II, 18 type IIIa, and 14 type IIIb) had identical management but in addition had an antibiotic bead pouch inserted into the open wound fo llowing debridement. Three amputations were performed: one (3.8%) in t he group treated without a bead pouch and two (3.6%) in the bead pouch group in patients with grade IIIb fractures and severe crushing injur ies. Of the remainder, there were four deep infections (16%) in the 15 fractures treated prior to the use of the bead pouch and two (4%) dee p infections in the 53 fractures following introduction of the bead po uch. Addition of the bead pouch to the wound management protocol was a ssociated with a worthwhile reduction of deep infection.