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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESurgical treatment of fractures is common, and therefore it is important to understand which approaches are most effective in reducing postoperative infections for these procedures. This article presents the results of a study of postoperative antibiotics for open reduction and internal fixation surgery for closed fractures [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00610987\u0026amp;atom=%2Fspmdc%2F14%2F41%2F18.atom\u0022\u003ENCT00610987\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESurgical treatment of fractures is common, and therefore it is important to understand which approaches are most effective in reducing postoperative infections for these procedures. Brett D. Crist, MD, University of Missouri, Columbia, Missouri, USA, presented the results of a study of postoperative antibiotics for open reduction and internal fixation (ORIF) surgery for closed fractures [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00610987\u0026amp;atom=%2Fspmdc%2F14%2F41%2F18.atom\u0022\u003ENCT00610987\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAlthough preoperative antibiotics are known to be effective in reducing infection, it is not clear whether postoperative antibiotics are also useful. Dr Crist noted that the Surgical Care Improvement Project increases the burden on hospitals and potentially on providers to use all possible means to reduce infections, increasing the importance of determining whether postoperative antibiotics are needed.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn this prospective, placebo-controlled, double-blinded study, adult patients receiving treatment for closed fractures (ORIF or prosthetic device placement) were randomized into 2 groups. All patients received 1 g of cefazolin intravenously prior to incision (2 g for patients weighing \u2265 80 kg) and then 1 g of cefazolin every 3 hours until completion of the surgery. The control group received 2 additional postoperative doses of 1 g of cefazolin administered at 8-hour intervals, whereas the treatment group received normal saline in identical packaging at the same postoperative intervals. Patients were followed up at 10 to 21 days, at 6 weeks, at 12 weeks, and at 6- to 8-week intervals until bony union occurred (for ORIF). Of the 229 patients initially randomized into treatment groups, 146 patients (75 in the antibiotic group and 71 in the placebo group) completed the full follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary outcome was presence or absence of infection, including superficial and deep infections. Deep infections were defined as those needing operative management. Descriptive statistics were calculated, and 6 risk factors were evaluated: smoking, age \u2265 65 years, diabetes mellitus, obesity, duration of surgery \u0026gt; 3 hours, and urinary catheterization. These risk factors, which were chosen because they have been associated with infection in previously published studies, were ranked from 0 (lowest risk) to 7 (highest risk).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThere was no significant difference in infection between the treatments, with 5.3% and 12.7% of patients developing infections in the antibiotic and placebo groups, respectively (\u003Cem\u003EP\u003C\/em\u003E = .12). There was also no significant difference in deep infection (\u003Cem\u003EP\u003C\/em\u003E = .33). Of the 6 risk factors examined, only diabetes (4.5 times greater risk of infection based on odds ratios) and duration of surgery \u0026gt; 3 hours (3.2 times greater risk of infection based on odds ratios) showed statistical significance (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15122\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15122\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15122\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ERisk Factors for Infection Following Surgery\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EBased on these results, Dr Crist concluded that postoperative antibiotics do not decrease the risk of infection. This is consistent with a previous meta-analysis by Slobogean and colleagues [\u003Cem\u003EJ Orthop Trauma.\u003C\/em\u003E 2008]. However, the current study differed from previous work in that it was placebo-controlled (unlike some others), focused on closed limb fractures, and used the preferred current cephalosporin antibiotic (cefazolin).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr Crist noted 2 limitations of the current study. First, the sample size was relatively small. Second, fracture types were combined. However, Dr Crist explained that combining fracture types increased the generalizability of the results and was consistent with other previous studies.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIn conclusion, Dr Crist stated that postoperative antibiotics may not make a difference, based on this underpowered study, but continuation of antibiotics should be considered in patients with diabetes or if the surgery is going to last for \u0026gt; 3 hours due to their significant increased risk of infection.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/41\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzolsq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzolsq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}