title: The use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial.
abstract: Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. One hundred and ninety-three adult patients with an open fracture of the distal phalanx were studied. Seven patients developed superficial infections, an overall infection rate of 4%. No patient developed osteitis or a deep wound infection. There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.
authors.affiliation: Accident and Emergency Department, Crosshouse Hospital, Kilmarnock, UK. james.stevenson@aaaht.scot.nhs.uk
authors.forename: J
authors.initials: J
authors.lastname: Stevenson
authors.forename: G
authors.initials: G
authors.lastname: McNaughton
authors.forename: J
authors.initials: J
authors.lastname: Riley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D005383:Finger Injuries / Q000628:therapy*; D005436:Floxacillin / Q000627:therapeutic use*; D005597:Fractures, Open / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011446:Prospective Studies; D012965:Sodium Chloride; D007507:Therapeutic Irrigation / Q000379:methods; D006113:United Kingdom / Q000453:epidemiology; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D005436:Floxacillin; D012965:Sodium Chloride