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Best evidence topic report
Antibiotics and compound finger fracture
Free
  1. Martin Thomas,
  2. Steve Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

    http://dx.doi.org/10.1136/emj.17.3.212-a

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      Report by Martin Thomas, Research FellowSearch checked by Steve Jones, Clinical Research Fellow

      Clinical scenario

      A 25 year old man attends the emergency department having trapped his right index finger in a door. He has a compound fracture of the distal phalanx. You wonder whether antibiotics should be given after wound care.

      Three part question

      In [patients with compound finger fractures] does [adding antibiotics] reduce [infection rates]?

      Search strategy

      Medline 1966–01/00 using the OVID interface. ({exp finger injuries OR exp fingers OR finger$.mp OR digit$.mp} AND {exp fractures, open OR open fracture$.mp OR compound fracture$.mp}) LIMIT to human AND english.

      Search outcome

      Altogether 61 papers found of which 59 were irrelevant or of insufficient quality. The remaining two papers are shown in table 1.

      View this table:
      Table 1

      Comments

      The two studies found come to quite different conclusions. The second paper specifies much more rigorous wound management and this may explain the outcome.

      Clinical bottom line

      All compound finger fractures should be rigorously cleaned and debrided. Antibiotics may reduce infection rates even more.

      Report by Martin Thomas, Research FellowSearch checked by Steve Jones, Clinical Research Fellow

      References

      1. Sloan JP, Dove AF, Maheson M, et al. Antibiotics in distal fractures of the distal phalanx? J Hand Surg (Br)1987;12:123–4.
        OpenUrlCrossRefPubMed
      2. Suprock MD, Hood JM, Lubahn JD. Role of antibiotics in open fractures of the finger. J Hand Surg (Am)1990;15:761–4.
        OpenUrlCrossRefPubMed