Effect of Prophylactic Antibiotics on K-Wire-Associated Infection: A Retrospective Cohort Study

TL;DR

This study found no significant difference in infection rates when using antibiotics before K-wire placement for bone fractures.

Contribution

The study provides new evidence on the effectiveness of prophylactic antibiotics for K-wire infections in orthopedic surgery.

Findings

The overall infection rate was 3.4% across all patients.

Antibiotic use did not significantly reduce infection rates (3.9% vs 2.4%).

The study was underpowered due to low infection rates and a small sample size.

Abstract

Introduction

Orthopaedic surgeons frequently manipulate and fix fractured bones into place using metal pins known as Kirschner wires (K-wires). The percutaneous placement of these wires makes them susceptible to infection at the pin site. Some surgeons choose to administer antibiotics prophylactically to prevent pin-site infection, while others do not; this variability is due to a lack of conclusive evidence in support of either practice. This study aims to investigate whether prophylactic antibiotics reduce the incidence of pin site infection by comparing those who received prophylaxis with those who did not.

Methods

A two-centre retrospective cohort study was performed. Records were reviewed for patients who underwent K-wire fixation of either supracondylar humerus or distal radius fractures at Leeds General Infirmary or Bradford Royal Infirmary between 2007 and 2021. Data was collected on antibiotic administration, pin-site infections, fracture location, age, sex, and comorbidities.

Results

A total of 264 patients met the eligibility criteria and had complete patient records. The overall incidence of K-wire-associated infection was 3.4%. In the group that received antibiotic prophylaxis, there was a higher incidence of infection (3.9% vs 2.4%); however, this result was not significant (OR 1.6, 95% CI 0.33-7.87, p=0.73).

Conclusions

This study detected no reduction in infection rates when using antibiotic prophylaxis; however, the results did not reach significance. The main study limitation was a small sample size. Due to infection rates being low, the study was underpowered to detect a small effect size. It is recommended that future randomised controlled trials and meta-analyses be carried out to provide significant conclusions and inform future practice.