Antibiotics in the Treatment of Low-velocity Gunshot-induced Fractures: A Systematic Literature Review
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Clin Orthop Relat Res DOI 10.1007/s11999-013-2884-z
A Publication of The Association of Bone and Joint Surgeons®
SYMPOSIUM: CIVILIAN GUNSHOT INJURIES
Antibiotics in the Treatment of Low-velocity Gunshot-induced Fractures A Systematic Literature Review Efthymios Papasoulis MD, Michael J. Patzakis MD, Charalampos G. Zalavras MD, PhD
Ó The Association of Bone and Joint Surgeons1 2013
Abstract Background Low-velocity gunshots are often associated with extremity fractures. There is no consensus, however, on the use of antibiotics for these injuries. Questions/purposes We performed a literature review to answer the following questions: (1) Are antibiotics needed for the treatment of these fractures? (2) Is gram-negative coverage necessary? (3) How long should antibiotics be administered? And (4) which is the optimal administration route? Methods We conducted a MEDLINE1 search and found only two relevant prospective, randomized studies. Further searches identified all case series with information on the use of antibiotics in gunshot fractures. In total, 33 studies provided enough data to answer the study questions. An assessment of the quality of the identified studies was . performed. Twenty-three studies met at least 1 2 of the quality items of the assessment tool.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. E. Papasoulis, M. J. Patzakis, C. G. Zalavras (&) Department of Orthopaedic Surgery, University of Southern California, Keck School of Medicine, 1200 N State Street, GNH-3900, Los Angeles, CA 90033, USA e-mail: [email protected]
Results Antibiotics did not significantly reduce the infection rate for fractures treated nonoperatively (1.7% with antibiotics versus 5.1% without) with the numbers available. There was no significant difference in infection rates when gram-negative coverage was added, either in nonoperatively treated fractures (1.7% versus 2.8%) or in operatively treated fractures (0% versus 2.5%). Duration of antibiotic administration did not significantly affect the infection rate. No difference was found between intravenous and oral antibiotic administration for nonoperatively treated fractures. Conclusions This literature review could not demonstrate a significant benefit with the use of antibiotics for lowvelocity gunshot fractures treated nonoperatively; however, the statistical power for these comparisons was low in the available literature, which is insufficiently strong t
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