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Journal of Hand Surgery (British and European Volume)
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The use of Prophylactic Flucloxacillin in Treatment of Open Fractures of the Distal Phalanx within an Accident and Emergency Department: A Double-Blind Randomized Placebo-Controlled Trial

J. STEVENSON
G. MCNAUGHTON
J. RILEY

From the Accident and Emergency Department, Crosshouse Hospital, Kilmarnock, UK; the Accident and Emergency Department, Royal Alexandra Hospital, Renfrewshire, UK and the Department of Mathematics, Glasgow Caledonian University, Glasgow, UK

Correspondence: Mr James Stevenson, Accident and Emergency Department, Crosshouse Hospital, Kilmarnock, Ayrshire KA2 0BE, UK. Tel.: +44-1563-521133; Fax: +44-1563-577731; E-mail: james.stevenson{at}aaaht.scot.nhs.uk

Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. One hundred and ninety-three adult patients with an open fracture of the distal phalanx were studied. Seven patients developed superficial infections, an overall infection rate of 4%. No patient developed osteitis or a deep wound infection. There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.

Key Words: open fracture • distal phalanx • antibiotic prophylaxis

Journal of Hand Surgery (British and European Volume), Vol. 28, No. 5, 388-394 (2003)
DOI: 10.1016/S0266-7681(03)00175-X
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