No significant benefit of administering peri-operative antibiotics for patients undergoing orthopaedic surgery using K-wire

Ahmad Abul et al conducted a study to compare the outcomes of antibiotic prophylaxis versus no antibiotic in K-wire fixation when used in either in trauma or elective orthopaedics. It has been published in “Indian Journal of Orthopaedics.”

Kirschner (K) wires are commonly used in orthopaedic surgery for fixation of unstable fractures such as supracondylar humerus fractures in paediatric patients, distal radius fractures in paediatric and adult patients and elective surgery of the foot.

There are currently no standardised guidelines on whether antibiotic prophylaxis is required for Kirschner wire (K-wire) fixation to minimise the risk of surgical site infection when used in patients undergoing clean orthopaedic surgery.

A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all randomised controlled trials (RCTs) and non-randomised studies comparing the outcomes of antibiotic prophylaxis group versus those without antibiotic in patients undergoing orthopaedic surgery in which K-wire fixation was used. Incidence of surgical site infection (SSI) was the primary outcome. Random effects modelling was used for the analysis.

Findings of the study were:

• Search strategy retrieved 181 studies and after a thorough screening of the retrieved articles, the authors identified five studies in total which met the eligibility criteria.

• Four retrospective cohort studies and one RCT were identified with a total of 2316 patients.

• There was no significant difference between the prophylactic antibiotic and no antibiotic groups in terms of incidence of SSI (odds ratio [OR]=0.72, P=0.18).

The authors commented – “In conclusion, based on the current available evidence there is no significant difference in administering perioperative antibiotics for patients undergoing fracture fixation with K-wire. Further high quality, prospective studies are required to improve the evidence base to influence guidelines.”

Further reading:

Peri operative Antibiotic Prophylaxis in K Wire Fixation: A Systematic Review and Meta analysis

Ahmad Abul, Mohammad Karam et al

Indian Journal of Orthopaedics (2023) 57:1000–1007

https://doi.org/10.1007/s43465-023-00879-6