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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.
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