SynthesisInternational orthopaedics2014
Systematic review and meta-analysis of the additional benefit of local prophylactic antibiotic therapy for infection rates in open tibia fractures treated with intramedullary nailing.
Synthesis in International orthopaedics, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers.
What it found
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Who cites it
50 citing papers in PubMed, 102 citations in OpenAlex.
- Translation-driven design: development of an antibiotic-loaded hydrogel for the management of orthopaedic device-related infection.Bioactive materials · 2026Article
- Epidemiology, determinants, and microbiological profile of implant-associated infections following intramedullary nailing in a tertiary hospital in Ethiopia.Archives of orthopaedic and trauma surgery · 2026Article
- Custom Antibiotic-Coated Intramedullary Nails for Infected Tibial and Femoral Nonunions: Retrospective Cohort Study and Surgical Technique.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
- Intramedullary nailing with absorbable antibiotic-eluting ceramic for fracture-related infection prophylaxis in high-risk open fractures: a case series and technique.OTA international : the open access journal of orthopaedic trauma · 2026Article
- Open Tibial Fractures Part 1: A Narrative Review of Initial Treatment and Potential Applicability to the Southern African Context.Orthopedic research and reviews · 2025Review
- Review
- Biofilm Formation, Antibiotic Resistance, and Infection (BARI): The Triangle of Death.Journal of clinical medicine · 2024Review
- Three predictive scores compared in a retrospective multicenter study of nonunion tibial shaft fracture.World journal of orthopedics · 2024Article
- [Importance of local antibiotics in the prophylaxis and treatment of fracture-associated infections].Unfallchirurgie (Heidelberg, Germany) · 2024Review
- Antibiotic-Coated Intramedullary Nailing Managing Long Bone Infected Non-Unions: A Meta-Analysis of Comparative Studies.Antibiotics (Basel, Switzerland) · 2024Review
- The Intraoperative Use of Defensive Antibacterial Coating (DACMaterials (Basel, Switzerland) · 2023Review
- A major trauma centre experience with gentamicin-coated tibial intramedullary nails (ETN PROtect™) in acute primary open fracture fixation and complex revision surgery.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- Outcomes after primary intramedullary nail fixation of open tibial and femoral fractures in low resource settings.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- Article
- Heat Accumulation-Induced Surface Structures at High Degrees of Laser Pulse Overlap on Ti6Al4V Surfaces by Femtosecond Laser Texturing.Materials (Basel, Switzerland) · 2023Article
- Hardware Infection From Surgical Stabilization of Rib Fractures Is Lower Than Previously Reported.Cureus · 2023Article
- Antibiotic-Loaded Coatings to Reduce Fracture-Related Infections: Retrospective Case Series of Patients with Increased Infectious Risk.Antibiotics (Basel, Switzerland) · 2023Article
- Evidence for Local Antibiotics in the Prevention of Infection in Orthopaedic Trauma.Journal of clinical medicine · 2022Review
- Does prophylactic local tobramycin injection lower open fracture infection rates?OTA international : the open access journal of orthopaedic trauma · 2022Article
- Does the Use of Local Antibiotics Affect Clinical Outcome of Patients with Fracture-Related Infection?Antibiotics (Basel, Switzerland) · 2022Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThis analysis compared the rate of deep wound infections in patients with open tibia fractures, treated with intramedullary nails, receiving additional locally-delivered antibiotics to those receiving standard care.
methodsTwo systematic literature searches identified studies reporting infection rates in patients treated with intramedullary nails for tibia fractures receiving systemic antibiotics only (search one) and in patients receiving adjunctive locally-administered antibiotics peri-operatively at the tissue-implant interface (search two). After applying inclusion and exclusion criteria, 14 and seven papers from searches one and two, respectively, were included in meta-analyses.
resultsThe absolute rate of infection was lower for all Gustilo-Anderson grades of tibia fractures when local antibiotics were administered as adjunctive prophylactic therapy. For severe fractures, classified as GAIII fractures, patients receiving systemic antibiotics only had an infection rate of 14.4 % [95 % CI: 10.5 %, 18.5 %]; adding local antibiotics reduced the rate to 2.4 % [0.0 %, 9.4 %], with an odds ratio of 0.17. Risk of deep wound infections increased with severity of fracture, rising to over 31 % in GIIIB&C fractures for patients receiving systematic antibiotics only, but to below 9 % with additional local antibiotics.
conclusionThe findings support consideration of augmenting the antibiotic prophylaxis regimen to include locally-delivered antibiotics. Patients with severe fractures will obtain greatest benefit from infections avoided. No trial directly compared the two treatments for open tibia fractures, limiting the ability to attribute the differences in observed infection rates directly to the treatments themselves. A large comparative study to improve the evidence on relative effect size is merited. LEVEL OF EVIDENCE: Level III.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.