![]() ![]() The wound was then bandaged with paraffin gauze dressing (“Jelonet Smith & Nephew”). Once satisfactory stability was achieved K-wires were bent and then cut short using wire cutters. Number of K-wires was determined using the Gartland classification system 12 2 K-wires used for type 2, 3 K-wires used for type 3 and a 4th wire added if required for stability. If a medial K-wire was used this was done last with a mini-open approach. Fractures were reduced with fluoroscopy and then stabilized with 2 mm K-wires inserted laterally with percutaneous pinning. Depending on surgeon’s preference, patients were either administered a dose of pre-operative antibiotics or not. The arm was then prepped and draped in the typical fashion using chlorhexidine gluconate 2% w/v and isopropyl alcohol 70% v/v solution (“ChloraPrep* One-Step”). Splinting was removed, pre-operative cleansing of the entire arm was carried out using 4% chlorhexidine gluconate (“BD E-Z Scrub 747”). All patients received a general anesthetic. All patients were placed in the supine position with the upper limb laid on an arm table. All patients treated in the operative room with full preparation and draping technique went through the same presurgical and surgical preparation of the arm. Operative care involved either semi-sterile or full preparation and draping techniques. ![]() This was independent of fracture type, severity or patient factors. ![]() All surgeon’s in the study preferred the exclusive use of either semi-sterile or full preparation and draping techniques in their fracture fixation. The primary outcome of infection was defined as any patient prescribed antibiotics for clinical signs of infection within 28 days after surgery. ![]() Exclusion criteria were as follows: open fractures patients converted to open reduction additional ipsilateral arm fractures immunocompromised patients and those without complete follow-up.Īge, sex, fracture type according to the Gartland classification system, 12 pre-operative antibiotic administration, operative preparation-to-incision time, number of K-wires, medial K-wire use, infectious and mechanical complications were recorded. Inclusion criteria were as follows: supracondylar fracture classified as either type 2 or 3 in the Gartland classification system 12 surgically repaired with CRPP K-wires (kirschner wires) left external to the skin patients aged 0 to 16 years and complete follow-up for visits at one- and three-weeks post-operative. In the current study the main hypothesis was that there would be no significant differences of infection rates in semi-sterile compared to full preparation and draping techniques.Ī retrospective review of medical records was performed for all patients aged 16 years of age or younger, who underwent CRPP of a supracondylar fracture at our institution between January 2014 and April 2018. The current retrospective study was therefore set up to compare infection rates, pre-operative antibiotic administration, preparation-to-incision time and cost in semi-sterile draping technique versus full preparation and draping in CRPP of supracondylar fractures. Surgical time and cost of semi-sterile and full preparation and draping techniques are not well reported in the literature. Note that Iobst et al 4 in their series of 304 patients found peri-operative antibiotics may not be necessary as 68% of their patients did not receive antibiotics in the perioperative or postoperative period resulting in zero infections. Broadly, pre-operative antibiotics are used by some surgeons and not by others. Debate still exists among surgeons whether full preparation and draping is safer than semi-sterile technique regarding infection risk. Iobst et al 4 in a series of 304 patients found zero infections with CRRP of supracondylar fractures using semi-sterile technique whereas Turgut et al 2 has recently shown that infection may be a matter of concern with 7.3% infection rates in the semi-sterile technique. Current literature estimates infection rates between 0% to 7.3% 1–11 in CRPP of supracondylar fractures. Semi-sterile and full preparation and draping techniques are commonly used in closed reduction percutaneous pinning (CRPP) of supracondylar fractures. ![]()
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