[When is antibiotic prophylaxis required?].

In situations where the local host damage (either traumatic or iatrogenically induced) is the predominant co-factor for the development of infection, the antibiotic or other pharmacological reduction of the bacterial colonisation is of secondary or no importance at all. On the one hand, excellent hygienic conditions have reduced more and more the relative importance of the bacterial contamination in aseptic procedures. On the other hand, the surgical-technical evolution in the last 5 years (such as biological osteosynthesis, unreamed intramedullary nailing, stepwise procedures in complex fractures, initial open wound treatment and very early plastic reconstruction in open fractures) could create a significant improvement of the conditions concerning prevention and treatment of infection. Therefore, the relative importance of associated antibiotic treatment has to be considered to be essentially lower.