O3262: Do Prophylactic Antibiotics Decrease Risk of Infection in Closed Percutaneous Pinning of Pediatric Hand Fractures?

Background: Infection rate after pediatric hand CRPP has been reported to be 2% in a small cohort (n=50, Battle & Carmichael, JPO 2007), while adult hand CRPP rates range from 7-16%. We are unaware of other established baseline rates of infection for this common pediatric surgery.

Methods: This is a retrospective study from 6 institutions of 739 pediatric patients who received closed reduction percutaneous pinning (CRPP) for a closed finger/hand fracture. The primary goal was to establish infection rates in this patient population, with a secondary objective of comparing infection rates between patients who received pre-operative prophylactic antibiotics (ABX) to those who did not receive pre-operative prophylactic antibiotics (NABX). Numerical variables were compared with t-test and Mann-Whitney tests; categorical variables were compared with chi-square or Fisher’s exact test. Pre-study power analysis found that 206 patients were needed in each cohort to show a difference between 2% (peds hand) and 8% (adult hand) infection rates (alpha 0.05, 80% power).

Results: There were 489 patients in the ABX cohort and 250 patients in the NABX cohort. This was a site-randomized study with 97% (243/250) of NABX from 2 institutions. Patient demographics and medical history were similar between the ABX and NABX groups (p>0.05). Statistically significant differences were found between cohorts with regards to fracture location, use of Jurgan Balls, post-operative immobilization, whether the cast was split, size and number of pins, fluoro time, time from surgery to pin pull, and length of follow-up (p < 0.05, Table 1). No differences were found in complications using the Clavien-Dindo classification. There was 1 superficial infection in the ABX group (0.2%) and 5 in the NABX group (2.00%), which was statistically significant (p=0.01). The low number of superficial infections precluded any further analysis of associated factors for superficial infection. There were no deep infections, physeal arrest, nonunions, implant failures, or Clavien-Dindo type IV complications.

Conclusion: In this large cohort, CRPP of pediatric hand fracture had a higher risk of superficial infection if patients did not receive pre-operative prophylactic antibiotics, but the rate of infection was similar to existing studies of this patient population. Antibiotic prophylaxis for CRPP of pediatric hand fractures results in fewer superficial infections.