title: Intrawound application of vancomycin reduces wound infection after open release of post-traumatic stiff elbows: a retrospective comparative study.
abstract: BACKGROUND
  With the improvements in wound healing through the use of intravenous prophylactic antibiotics and technical refinements, postoperative elbow infections have become less common but still occur in certain elective elbow surgeries. The objective of this study was to evaluate the safety and efficacy of prophylactic application of vancomycin into the operative site to reduce the incidence of infection after the open release of post-traumatic stiff elbows.
  
  
  METHODS
  A retrospective review of 272 such patients during a 4-year period was performed. In the control group (93 patients), simple prophylaxis with standard intravenous antibiotics was performed; in the vancomycin group (179 patients), vancomycin powder was applied directly into the wound before closure along with standard intravenous prophylaxis.
  
  
  RESULTS
  After a follow-up of at least 6 months, the control group was found to have 6 infections (6.45%; confidence interval: 2.40%-13.52%) compared with none (0%; confidence interval: 0-2%.04%) in the vancomycin group, which was a statistically significant difference (P = .0027). No adverse effects were documented from the direct use of the vancomycin powder.
  
  
  CONCLUSIONS
  The local application of vancomycin powder may be a promising means of preventing postoperative elbow infections after elbow release in patients with post-traumatic elbow stiffness.
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Division of Plastic and Hand Surgery, Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Hede
authors.initials: H
authors.lastname: Yan
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Jin
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Shiyang
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: fancunyi888@gmail.com.
authors.forename: Cunyi
authors.initials: C
authors.lastname: Fan
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D016022:Case-Control Studies; D002437:Cefazolin / Q000008:administration & dosage; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D011208:Powders / Q000008:administration & dosage; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*; D055815:Young Adult; D000092464:Elbow Injuries
chemical_list: D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin; D002437:Cefazolin
keywords: Post-traumatic stiff elbow; elbow stiffness; local application; open release; vancomycin; wound infection