THE ROLE OF LOCAL ANTIBIOTIC-THERAPY IN THE MANAGEMENT OF COMPOUND FRACTURES

Seven hundred four compound fractures (198 [28%] Grade I, 259 [37%] Gr ade II, and 247[35%] Grade III) were treated during a seven-year perio d at the authors' institution. One hundred fifty-seven open fractures (22%) (Group A) received systemic antibiotic prophylaxis only, whereas 547 compound fractures (78%) (Group B) were treated with local applic ation of antibiotic beads (tobramycin) in addition to prophylaxis. Fra cture grades, age, gender, fracture location, and length of follow-up period were not significantly different between the two groups. All fr actures underwent timely irrigation, debridement, and skeletal stabili zation. Forty-nine of 704 compound fractures (7%) developed an infecti on (acute wound infection or chronic osteomyelitis or both). Group A s howed an infection rate of 17% (26/157), treatment in Group B resulted in 23 compound fracture infections (4.2%). The difference in the inci dence of infection was statistically significant. Comparison of the in fection rates in either wound infection or chronic osteomyelitis showe d a trend toward decreased rates in Group B versus Group A throughout all fracture grades. However, by subdivision into the fracture grades, only the IIIB types had a statistically significant decrease of infec tion in Group B versus Group A; the wound infection rate was 39% (9/23 ) in Group A and 7.3% (7/96) in Group B. The rate of chronic osteomyel itis was 26% (6/23) in Group A and 6.3% (6/96) in Group B. Prophylacti c use of antibiotic-laden PMMA beads in addition to systemic antibioti cs was of benefit in preventing infectious complications in compound f ractures, in particular in Type IIIB open fractures.