Open limb fractures: Do antibiotics help?

Antibiotics improve healing and prevent infections after open limb fractures, and they are a key element of treatment.

An open limb fracture is when a broken bone comes through the skin. It is almost impossible to stop bacteria getting into the wound.

Often this has no consequences. However if the wound becomes infected or even starts to fester, it can badly interfere with healing of the wound and the bone. In extreme cases this can even lead to the need for amputation.

To prevent this kind of complication, the wound is usually cleaned and damaged tissue removed when necessary. It is routine in Germany for patients to be given several days of antibiotic treatment.

To find out how necessary this is, researchers from the Cochrane Collaboration gathered and analysed trials testing this treatment. They found seven trials, in which more than 900 patients with open fractures of the finger, hand, arm or leg tested antibiotic treatment.

The results clearly supported routine antibiotics. Out of 100 patients who had no antibiotics, 13 developed a wound infection in the days after the fracture (13%). But out of 100 patients who got antibiotics, there were only 6 infections (6%).

A further finding was that antibiotics give the most protection when they are started early, preferably in the first six to eight hours after the break. The trials could not show, however, whether any particular antibiotic is better than others.

The benefit was so clear, that the researchers concluded that antibiotic treatment after an open limb fracture is a basic element of care, and should not just be seen as a precaution. Patients also need to know about the importance of taking antibiotics in this situation.

© IQWiG (Institute for Quality and Efficiency in Health Care)