There is little data to support the efficacy of prophylactic
antibiotics in traumatology. In
closed fractures three randomized controlled studies using a 1-3 day prophylaxis with
Cephalosporins of the first or second generation or a
Penicillinase-resistent
Penicillin demonstrated a reduction of the
infection rate. For the
Cephalosporins of the second generation it was shown, that a single dose was less efficient than five repeated applications over 24 hours. In
hip-fractures a prophylaxis with
Cephalothin or
Cefotiam reduced the frequency of
infections when compared with controls. In
open fractures a treatment over 10 days using
Cephalothin or Isoxazolyl-
Penicillin showed a significant drop of the
infection rate. If however the fractures were not treated using the principles of rigid internal fixation and were covered with
Dicloxacillin over 2 days only there was no significant improvement. A multicenter study finally indicates that a one day course of
cefonicid sodium is not inferior to a prolonged course of
antibiotics for prevention of early postoperative fracture-site
infections. We conclude, that open and
closed fractures can profit from
antibiotic prophylaxis which starts immediately before surgery and is continued over 24 hours. We favour Isoxazolyl-
Penicillin because of its efficacy against staphylococcus aureus and epidermidis which predominate in early
infection. In established bone and
soft tissue infections antibiotics are used when there is local spreading,
sepsis, involvement of joints or when reinterventions in the infectious focus are necessary. In these cases bacteriological testing in the laboratory is essential for the selection of
antibiotics. Local application of
antibiotics in irrigation-drainage solutions can not be recommended.
PMMA-chains serve as temporary spacers, but should be removed early before their extraction becomes difficult and resistant bacteria develop. When defects are closed with cancellous bone or soft tissues the use of
Gentamycin-fleece or
Taurolin-
gels is recommended.