Effect of Intrawound Vancomycin Powder as an Adjunct to Systemic Antibiotic Prophylaxis on Surgical Site Infection Following Open Tibial Fracture Fixation: A Randomized Prospective Study.

Introduction: Surgical site infection (SSI) remains a major complication following open tibial fracture fixation, often leading to prolonged hospitalization, delayed union, and increased healthcare burden. Topical vancomycin powder has emerged as a potential adjunct to standard systemic prophylaxis to reduce post-operative infections in orthopedic trauma. Objectives: To compare the effectiveness of topical vancomycin powder versus standard prophylaxis alone in preventing SSI after open tibial fracture fixation. Materials and Methods: This randomized prospective study included 50 patients with Gustilo-Anderson Grade I-IIIA open tibial fractures. Participants were allocated into two equal groups: Group A received 1 g intrawound vancomycin powder in addition to standard systemic antibiotics, whereas Group B received systemic prophylaxis alone. The primary outcome was SSI incidence within 12 weeks. Secondary outcomes included time to infection, microorganism profile, wound complications, reoperation rates, and fracture healing. Data were analyzed using the Statistical Package for the Social Sciences, with P < 0.05 considered statistically significant. Results: Group A demonstrated significantly lower total SSI (8%) compared to Group B (32%, P = 0.03). Deep SSI was markedly reduced with vancomycin use (4% vs. 20%, P = 0.04). MRSA infections were absent in Group A but present in 16% of Group B. Reoperations for debridement were also lower in Group A (4% vs. 20%). No adverse effects on wound healing or radiological union were observed. Time to infection was longer in Group A, indicating better early protection. Conclusion: Topical vancomycin powder significantly reduced post-operative SSI without impairing healing, suggesting a valuable adjunct to standard prophylaxis in open tibial fracture fixation.