# Is Perioperative Antibiotic Prophylaxis Necessary for Pediatric and Adolescent ESIN Osteosyntheses?—A Retrospective Analysis of 939 Surgical Procedures

## TL;DR

This study examines whether antibiotic use is necessary during pediatric ESIN procedures and finds that complications are rare regardless of antibiotic use.

## Contribution

The study provides evidence that PAP may not be necessary for ESIN osteosyntheses in children.

## Key findings

- Complications occurred in 14.7% of cases, but serious infections were rare at 1.7%.
- No significant differences in complications were found between subgroups with or without PAP.
- Closed reduction without PAP did not increase the risk of complications.

## Abstract

Background: Elastic stable intramedullary nailing (ESIN) is widely used in pediatric trauma surgery for benefits such as early limb loading, short hospital stays, and easy implant removal. Perioperative antibiotic prophylaxis (PAP) is used to reduce surgical site infections (SSIs). However, the necessity of PAP in minimally invasive pediatric procedures like ESIN remains unclear. Methods: This retrospective analysis reviewed all pediatric fractures treated with ESIN osteosynthesis at a pediatric trauma center over a time span of 10 years. Focus was set on the use of PAP during implantation and complications in the period between osteosynthesis and implant removal, which was used as follow-up. Results: Between January 2013 and December 2023, a total of 979 ESIN osteosyntheses were performed. In total, 4.1% were lost to follow-up resulting in 939 eligible cases. Complications occurred in 14.7% of all cases. However, complications such as wound healing disorders, wound infections, and osteomyelitis were rare, at 1.7%. Between the different subgroups regarding the application of PAP, type of reduction, openness of the fractures, or localization, no significant differences were found. Conclusions: Besides the most minor complications, ESIN osteosynthesis in children and adolescents is safe treatment. No increased risk for complications was observed when closed reduction was performed without the administration of PAP.