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'Spray-and-Towel' Method Without Preoperative Antibiotics as Effective as 'Full Prep-and-Drape' With Antibiotics for Preventing Infection Following Closed Reduction and Percutaneous Pinning of Supracondylar Humerus Fractures in Children: Presented at AAP By Nora Steiner Mealy SAN FRANCISCO, CA -- October 30, 2007 -- Semi-sterile technique without preoperative intravenous antibiotics was found to be as effective in preventing infections as full-skin preparation and formal draping along with antibiotic administration following closed reduction and percutaneous pinning (CRPP) of supracondylar humerus fractures in children, according to research presented here at the American Academy of Pediatrics (AAP) National Conference and Exhibition. Supracondylar humerus fractures are the most common elbow fractures in children. Most can be managed with CRPP, which has been previously found in numerous studies to be safe and effective. However, reported practices vary widely regarding use of preoperative antibiotics and techniques used for skin preparation. Ravi K. Bashyal, MD, of the Department of Orthopaedic Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri, United States, one of the study authors, presented the findings that involved data collected on patients who were treated by 8 surgeons during an 11-year period. No preoperative antibiotics were administered in 391 cases (52%), and simple spray preparation and towel isolation of the area was used for skin preparation in 417 cases (56%). A total of 9 postoperative infections (1.2%) developed, with 8 being superficial and treated with oral antibiotics and 1 being osteomyelitis requiring intravenous antibiotics. No significant differences in infection rates were found between the different treatment groups. Except in the case of osteomyelitis, in which the patient was febrile, no indication of infection was apparent in the cases of infection until cast removal. According to Dr. Bashyal, the study confirmed previous findings that infection rates with CRPP of supracondylar humerus fractures in children are low. "Preoperative antibiotics do not seem to substantially lower the infection rate, and we question the routine use of intravenous antibiotics in these cases," said Dr. Bashyal. "There does not seem to be any advantage to completely draping the extremity, and we recommend a simple spray preparation and towel isolation of the area during pinning." [Presentation title: Variations in Preoperative Antibiotic Use and Skin Preparation: Effect on Infection Rates Following Closed Reduction and Percutaneous Pinning of Supracondylar Humerus Fractures in Children. Abstract 828] E-mail this page to a friend or colleague! To print, use this version