Supracondylar Fractures: A Retrospective Chart Review Comparing Infection Rate, Antibiotic Use, Surgical Time and Cost of Full Surgical Preparation and Draping vs “Semi-Sterile” Technique

Abstract

Ian Laxdal,1 Kevin Stockwell,1 Mark Xu,1 Jonathan Tan,1 Sheila McRae,1,2 Paul Jellicoe1 1Department of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada; 2Pan Am Clinic Foundation, Winnipeg, MB, CanadaCorrespondence: Ian LaxdalDepartment of Orthopedic Surgery, University of Manitoba, AD4 – 820 Sherbrook Street, Winnipeg, MB R3A 1R9, CanadaEmail [email protected]: Semi-sterile and full preparation and draping techniques are commonly used in closed reduction percutaneous pinning (CRPP) of supracondylar fractures. Debate exists whether full preparation and draping is safer than semi-sterile technique in regards to infection risk and the utility of pre-operative antibiotics. This study is a comparison of infection rates, pre-operative antibiotic administration, cost and surgical time between techniques.Methods: A retrospective chart review of 336 pediatric patients with supracondylar fractures repaired with CRPP at our institution was completed between January 2014 and April 2018, 168 per technique. Infection rates, pre-operative antibiotic administration, preparation-to-incision time and cost in semi-sterile draping versus full preparation and draping techniques were compared.Results: Of the 336 patients, 1/168 (0.1%) in the full preparation and draping group developed an infection compared to 0/168 (0%) patients in the semi-sterile group. Pre-operative antibiotics (Cefazolin) were administered to 76/168 (23%) patients in the full preparation and draping group and 0/168 (0%) in the semi-sterile group. The infection found received pre-operative antibiotics. Mean preparation-to-incision time for the semi-sterile group was 2.4± 2.0 minutes and the full preparation and draping group was 9.9 ± 4.2 minutes (p < 0.001). Surgical supply cost was $80.72 [CDN] and 108.24$ [CDN], respectively, for the semi-sterile and full preparation and draping groups.Conclusion: Risk of infection using a semi-sterile draping technique was safe and comparable to a full preparation and draping technique when used in CRPP of supracondylar fractures. The administration of pre-operative antibiotics does not appear to make a difference in infection rates. Semi-sterile operative technique is cost effective and has decreased preparation-to-incision time.Keywords: supracondylar, fracture, infections, pediatric, trauma, cost

Keywords

• supracondylar
• fracture
• infections
• pediatric
• trauma
• cost