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Skin Antisepsis before Surgical Fixation of Extremity Fractures.

N Engl J Med

February 2024

From the Division of Orthopedic Surgery, Department of Surgery (S.S., H.J., J.A.-A., J.L., D.P., S. Bzovsky, O.P.S., J.L.G., M.B.), and the Department of Health Research Methods, Evidence, and Impact (L.T., D.H.-A., G.G.), McMaster University, Hamilton Health Sciences Hospital, General Site (F.M.), and the Population Health Research Institute (P.J.D.), Hamilton, ON, and the Department of Orthopedic Surgery, University of British Columbia, Vancouver (D.V., K.L.A.) - all in Canada; the Center for Orthopedic Injury Research and Innovation, Department of Orthopedics, University of Maryland School of Medicine (G.S., N.N.O.), and the Division of Infectious Diseases (M.J.) and the Division of Orthopedic Traumatology, Department of Orthopedics (G.S., M.J.G., R.V.O.), R. Adams Cowley Shock Trauma Center, the Trauma Survivors Network (J.L.W.) and Patient Representative (D.M., J.E.P., J.F.), University of Maryland Baltimore, the University of Maryland School of Pharmacy (C.D.M.), the Departments of Epidemiology and Public Health (A.D.H., J.N.H., L.M.O.) and of Medicine (G.M.S.), University of Maryland School of Medicine, Baltimore, and the Division of Orthopedic Traumatology, Department of Orthopedics, University of Maryland Capital Region Health, Largo (T.J., H.K.D.) - all in Maryland; the Association of periOperative Registered Nurses, Denver (A.W.); the Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Fairfax, VA (R.A.H., G.E.G.); the Department of Orthopedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem (H.T.P., E.A.C., S. Babcock, J.J.H.), the Division of Orthopedic Trauma, Atrium Health, Charlotte (K.D.P., L.B.K., M.K.), and the Department of Orthopedic Surgery, Duke University, Durham (R.M.R.) - all in North Carolina; the Department of Orthopedic Surgery, MetroHealth Medical Center, Cleveland (N.M.R., C.A.M.); the Department of Orthopedic Surgery, University of Utah, Salt Lake City (T.F.H., L.S.M.); the Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson (P.F.B., J.M.); the Division of Orthopedic Surgery, Sanford Health USD Medical Center, Sioux Falls, SD (R.E.V.D.); the Division of Orthopedic Surgery, Northwest Texas Healthcare System, Amarillo (G.D.P.); the Department of Orthopedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (I.L.G., G.C.); the Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison (C.M.D., G.R.K.); the Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School (M.J.W., A.G.K.), Carl J. Shapiro Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center (M.F.M.), and the Department of Orthopedic Surgery, Harvard Medical School (A. Alnasser) - all in Boston; the Department of Orthopedics, Miller School of Medicine, University of Miami, Miami (M.H.); the Division of Orthopedic Trauma, Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia (S.M., D.J.D.); the Division of Orthopedic Trauma, Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis (R.M.N., J.S.); Bryan Health, Lincoln, NE (A.N.S., S.F.S.); the Department of Orthopedic Surgery, Prisma Health-Upstate, Greenville, SC (K.J.J., S.L.T.); the Department of Orthopedic Surgery, University of California, San Francisco, San Francisco (M.T.M., A.M.), the Department of Orthopedic Surgery, Cedars-Sinai Medical Center (C.A.L., C.N.M.), the Department of Orthopedic Surgery, Keck School of Medicine of the University of Southern California (J.T.P.), and the Department of Orthopedic Surgery, UCLA (C.L.), Los Angeles, and the Department of Orthopedic Surgery, University of California, Irvine, Irvine (J.A.S., A. Amirhekmat) - all in California; the Department of Orthopedic Surgery, Brooke Army Medical Center (J.T.F., J.C.R.), and the Department of Orthopedic Surgery, San Antonio Military Medical Center (S.N.P.) - both in Fort Sam Houston, TX; the Department of Orthopedic Surgery and Sports Medicine, University of Cincinnati, Cincinnati (M.J.B.); the Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI (C.G.T.); the Department of Orthopedic Surgery, University of Missouri, Columbia (G.J.D.R.); Louisiana State University Health Sciences Center Orthopedics New Orleans, New Orleans (R.D.Z.); and the Department of Orthopedic Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany (J.-C.G.D.).

Article Synopsis

A study conducted at 25 hospitals compared the effectiveness of two antiseptic solutions (iodine povacrylex and chlorhexidine gluconate) in preventing surgical-site infections during extremity fracture surgeries.
Results showed that iodine povacrylex led to a lower rate of infections in patients with closed fractures (2.4% vs. 3.3%) but did not show a significant difference for open fractures (6.5% vs. 7.3%).
Ultimately, the study concluded that iodine povacrylex is a more effective skin antiseptic for closed extremity fractures, resulting in fewer infections compared to chlorhexidine, though both had similar outcomes for reoperations and adverse events.

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