EC Orthopaedics

Introduction: The evidence is building that adding topical antibiotic to standard systemic antibiotic in management of open fractures is lowering the infection rate and complications, however, there is a scarcity of studies in low resource settings. This study aims to evaluate the effect of topical antibiotic on infection rate in open fractures managed in limited-resource settings.

Methods: This is a prospective randomised controlled trial comparing topical antibiotic (aqueous gentamycin) and non-topical antibiotic groups. The primary outcome measures were chronic infection rate while the secondary outcome measures included the length of hospital stay, number of surgical procedures and rate of non-union.

Results: We recorded a significant reduction of infection rate in the 2^nd (p = 0.015) and 6^th (p = 0.045) weeks, but non-significant reduction at 6^th month (p = 0.3) in the topical group compared to the non-topical group. As compared to the non-topical group, for the topical group we recorded a reduced number of procedures (p = 0.004), reduced length of hospital stay (p = 0.006), the rate of non-unions at 6-month follow-up (p = 0.01).

Conclusion: This study shows that in the management of open long bone fractures in low-resource settings, the use of local aqueous gentamycin administration as an adjunct to conventional management is effective in lowering the infection rates, reducing the number of operations, reducing length of hospital stay and non-union rates. Despite some methodological limitations, the authors hope the study contributes to the body of evidence for the use of topical antibiotics in the management of open fractures.

Keywords: Open Fractures Management; Topical Antibiotics; Infection Rate; Non-Union Rate

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