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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.
({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.

Search 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)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Sloan JP, 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%
Suprock MD, et al. 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

Comment(s)

The two studies found come to quite different conclusions. The latter specifies much more rigourous wound management and this may explain the outcome.

Clinical 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

1. Sloan JP, Dove AF, Maheson M et al. Antibiotics in open fractures of the distal phalanx? J Hand Surg (Br) 1987;12(1):123-4.
2. Suprock MD, Hood JM, Lubahn JD. Role of antibiotics in open fractures of the finger. J Hand Surg (Am) 1990;15(5):761-4.