LOCAL ANTIBIOTIC-THERAPY FOR SEVERE OPEN FRACTURES - A REVIEW OF 1085CONSECUTIVE CASES

We reviewed 1085 consecutive compound limb fractures treated in 914 pa tients at the University of Louisville over a nine-year period, Of the se fractures, 240 (group 1) received only systemic antibiotic prophyla xis and 845 (group 2) were managed by the supplementary local use of a minoglycoside-polymethylmethacrylate (PMMA) beads. There were no signi ficant differences in age, gender, fracture type, fracture location or follow-up between the two groups. All had copious irrigation, meticul ous debridement and stabilisation, but wound management and the use of local antibiotic depended on the surgeon's individual preference and there was no randomisation. In group 1 there was an overall infection rate of 12% as against 3.7% in group 2 (p<0.001). Both acute infection and local osteomyelitis showed a decreased incidence in group 2, but this was statistically significant only in Gustilo type-IIIB and type- IIIC fractures for acute infection, and only in type-II and type-IIIB fractures for chronic osteomyelitis. Our review suggests that the adju vant use of local antibiotic-laden PMMA beads may reduce the incidence of infection in severe compound fractures.