Surgical site infections following orthopaedic surgery are a serious complication associated with increased morbidity and mortality. Intra-wound antibiotic powder may be able to provide infection prophylaxis locally with less systemic adverse effects, and promising results have been reported in systematic reviews of its use in spine surgery. This study aims to analyse the efficacy and adverse effect profile of intra-wound antibiotics in reducing surgical site infections in orthopaedic surgery for traumatic pelvic and lower limb fractures.

A systematic review was conducted for studies reporting on the incidence of surgical site infections following administration of intra-wound antibiotic powder in pelvic and lower limb trauma surgery. Randomised controlled trials, cohort and case-control studies were included. A meta-analysis was conducted for deep surgical site infections.

Seven studies were included in the systematic review including six retrospective case-control studies and one randomised controlled trial. Results of the meta-analysis suggest a potential 23% reduction in the odds of developing a deep surgical site infection in patients treated with intra-operative antibiotic powder compared with those managed with intravenous antibiotics alone (OR 0.77, 95% CI 0.52 – 1.13), although the results did not reach statistical significance.

Notable selective bias against intra-wound antibiotics and suboptimal study design were found in the retrospective studies, however the randomised controlled trial reported a significant reduction in deep surgical site infections with intra-wound vancomycin powder. There were no reports of systemic adverse outcomes and minimal risk of wound complications with the use of intra-wound antibiotics.

This review suggests the use of intra-wound antibiotic powder in pelvic and lower limb trauma surgery may reduce the incidence of deep surgical site infections. Further powered studies including randomised controlled trials are required to confirm the results highlighted in this study.

Background: There are various sites for pin placement in the pelvis. Recent studies have suggested that the supra acetabular pin placement is mechanically stronger and has been recommended as an alternative. The aim of this study is to analyse the morbidity of the most commonly used pin placement sites namely, conventional pin placement into the anterior iliac crest versus the low pin placement into the supra acetabular region.

Methods: Sixty one patients who required pelvic external fixation as part of their management between April 1998 and December 2001 were identified. Three patients died and were excluded from the study. Of the remaining 58 patients, 33 were treated with a supra-acetabular external fixator and 25 had an iliac crest external fixator. The majority of patients sustained the pelvic fracture as a result of road traffic accident. There were no statistically significant differences in the number of patients, mean age, length of stay, ISS or type of fractures for the two patient groups.

Results: Fewer complications were noted in the supra-acetabular group versus the iliac crest group (21.2% vs. 56.0%, p< 0.05). In particular, infection rates were significantly lower in the supra-acetabular group (15.1% vs. 36%, p< 0.05). There were no significant differences between the two groups in the number of pin cut-outs or misplacements, injury to the lateral femoral cutaneous nerve or loss of reduction.

Conclusion: The supra-acetabular technique of pin insertion for pelvic external fixation has fewer complications and should be utilised if an image intensifier is available. The lower rate of pin tract infection is a favourable outcome when secondary pelvic reconstructive procedures are necessary.