Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute.
OrthoCarolina, Charlotte, NC.
J Pediatr Orthop. 2022;42(5):e474-e479. doi: 10.1097/BPO.0000000000002118.
Supracondylar humerus (SCH) fracture is the most common elbow injury in children and often treated with closed reduction and percutaneous pinning (CRPP). There is little published evidence supporting or refuting the use of perioperative prophylactic antibiotics for SCH CRPP in the pediatric population. The purpose of this study is to evaluate the rate of surgical site infection for patients with and without preoperative antibiotics.
A retrospective chart review was conducted of patients less than or equal to 16 years from 2012 to 2018 who underwent primary CRPP. Open fractures, multilimbed polytraumas, and immunodeficient patients were excluded. Infection rates were compared using a noninferiority test assuming a 3% infection rate and a predefined noninferiority margin of 4%. A total of 255 patients were needed to adequately power the study.
Of the 1253 cases identified, 845 met eligibility criteria. A total of 337 received antibiotics, and 508 did not. Preoperative nerve injury (P=0.0244) and sterilization technique (P<0.0001) were associated with antibiotic use: 4 patients developed an infection; there were successfully treated superficial infections, and 1 was a deep infection requiring a formal debridement. There were 8 patients that had a recorded mal-union, and 6 patients required additional procedures; 1 patient had a postoperative compartment syndrome on postoperation day 1. The infection rates among patients treated with and without antibiotics were 0.60% and 0.40%, respectively. The absence of antibiotics was not clinically inferior to using antibiotics (P=0.003).
Infection remains a rare complication following CRPP of SCH fractures. According to our current data, not giving perioperative antibiotics was not inferior to using perioperative antibiotics for preventing superficial or deep infection in patients undergoing CRPP of SCH fractures. With the increase in attention to antibiotic stewardship, it is important to eliminate unnecessary antibiotic use while continuing to maintain a low rate of surgical site infection.
Level IV-case series. This is a therapeutic study that investigates the results from a case series.
肱骨髁上骨折（SCH）是儿童中最常见的肘部损伤，常采用闭合复位和经皮钢针固定（CRPP）治疗。尽管有少量文献支持或反驳在小儿人群中对 SCH CRPP 使用围手术期预防性抗生素，但实际上很少有相关研究。本研究旨在评估使用和不使用术前抗生素的患者的手术部位感染率。
对 2012 年至 2018 年间接受初次 CRPP 的年龄小于或等于 16 岁的患者进行回顾性病历审查。排除开放性骨折、多部位多发伤和免疫缺陷患者。使用非劣效性检验比较感染率，假设感染率为 3%，预设非劣效性边界为 4%。需要总共 255 例患者才能充分研究。
在确定的 1253 例病例中，845 例符合入选标准。共有 337 例患者接受了抗生素治疗，508 例患者未接受抗生素治疗。术前神经损伤（P=0.0244）和消毒技术（P<0.0001）与抗生素的使用相关：4 例患者发生感染；其中有 1 例成功治疗了浅表感染，1 例为深部感染，需要进行正式清创术。有 8 例患者出现记录不良愈合，6 例患者需要进一步治疗；1 例患者术后第 1 天发生术后骨筋膜室综合征。接受抗生素治疗和未接受抗生素治疗的患者感染率分别为 0.60%和 0.40%。未使用抗生素并不逊于使用抗生素（P=0.003）。
CRPP 治疗 SCH 骨折后感染仍然是一种罕见的并发症。根据我们目前的数据，对于接受 CRPP 治疗 SCH 骨折的患者，不给予围手术期抗生素与使用围手术期抗生素预防浅表或深部感染并无差异。随着对抗生素管理的重视程度不断提高，在继续保持低手术部位感染率的同时，消除不必要的抗生素使用非常重要。
IV 级-病例系列。这是一项治疗性研究，调查了病例系列的结果。
