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Reamed Nailing of Open Tibial Fractures: Does the Antibiotic Bead Pouch Reduce the Deep Infection Rate?

Keating, J. F.; Blachut, P. A.; O'Brien, P. J.; Meek, R. N.; Broekhuyse, H.

Journal of Orthopaedic Trauma: July 1996 - Volume 10 - Issue 5 - p 298-303
Original Article
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Summary Eighty-one open tibial fractures were treated by reamed intramedullary nailing. There were 38 type II, 23 type IIIa and 20 type IIIb injuries. 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 type II, 18 type IIIa, and 14 type IIIb) had identical management but in addition had an antibiotic bead pouch inserted into the open wound following debridement. Three amputations were performed: one (3.8%) in the group treated without a bead pouch and two (3.6%) in the bead pouch group in patients with grade IIIb fractures and severe crushing injuries. Of the remainder, there were four deep infections (16%) in the 25 fractures treated prior to the use of the bead pouch and two (4%) deep infections in the 53 fractures following introduction of the bead pouch. Addition of the bead pouch to the wound management protocol was associated with a worthwhile reduction of deep infection.

Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, British Columbia, Canada

Accepted November 18, 1995.

Address correspondence and reprint requests to J. F. Keating, M.Phil., Department of Orthopaedic Trauma, Royal Infirmary, Lauriston Pl., Edinburgh EH3 9YW, Scotland.

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