Antibiotics and compound finger fracture
Date First Published:
March 1, 2000
Last Updated:
May 17, 2001
Report by:
Martin Thomas, Research Fellow (Manchester Royal Infirmary)
Search checked by:
Steve Jones, Manchester Royal Infirmary
Three-Part Question:
In [patients with compound finger fractures] does [adding antibiotics] reduce [infection rates]?
Clinical Scenario:
A 25 year old man atttends the emergency department having trapped his right index finger in a door. He has a compound fracture of the distal phalanx. You wonder whether antibiotics should be given after wound care.
Search Strategy:
Medline 1966-01/00 using the OVID interface.
Search Details:
({exp finger injuries OR exp fingers OR finger$.mp OR digit$.mp} AND {exp fractures, open OR open fracture$.mp OR compound fracture$.mp}) LIMIT to human AND english.
Outcome:
61 papers found of which 59 were irrelevant or of insufficient quality. The remaining 2 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Antibiotics in open fractures of the distal phalanx? Sloan JP, Dove AF, Maheson M et al. 1987 UK. | 85 adult patients with recent (< 6h) open fractures of the distal phalanges. no antibiotic vs cephradine. |
Controlled clinical trial. | Infection rate | 30% vs < 3% | |
| Role of antibiotics in open fractures of the finger. Suprock MD, Hood JM, Lubahn JD. 1990 USA. | 91 patients with open fractures of the finger. Surgical irrigation and debridement with or without antibiotics. |
Controlled clinical trial. | Number of infections | 4 in each group |
Author Commentary:
The two studies found come to quite different conclusions. The latter specifies much more rigourous wound management and this may explain the outcome.
Bottom Line:
All compound finger fractures should be rigourously cleaned and debrided. If this is not possibe then antibiotics will significantly reduce infection rates.
References:
- Sloan JP, Dove AF, Maheson M et al.. Antibiotics in open fractures of the distal phalanx?
- Suprock MD, Hood JM, Lubahn JD.. Role of antibiotics in open fractures of the finger.