Dickson Wak

Title : A randomised control trial to compare topical use of antibiotic versus conventional management of open fractures

Abstract:

Introduction:
The evidence is building that adding topical antibiotic to standard systemic antibiotic in management of open fractures is lowering the infection rate and complications, however, there is a scarcity of studies in low resource settings. This study aims to evaluate the effect of topical antibiotic on infection rate in open fractures managed in limited-resource settings.
Methods:
This is a prospective randomised controlled trial comparing topical antibiotic (aqueous gentamycin) and non-topical antibiotic groups. A total of 200 patients with open long bone fractures were admitted, of which 120 patients gave consent and were randomly allocated into the study groups. Eighty patients were excluded from the study. The primary outcome measures were acute infection rate while the secondary outcome measures included the length of hospital stay, number of surgical procedures and rate of non-union.
Results:
The mean time of injury to the time of first debridement was 6 days and the delays were observed in all stages due to poor access to surgical care. We recorded a significant reduction of infection rate in the 2^nd (p = 0.015) and 6^th (p = 0.045) weeks, but non-significant reduction at 6th month (p = 0.3) in the topical group compared to the non-topical group. As compared to the non-topical group, for the topical group we recorded a reduced number of procedures (p = 0.004), reduced length of hospital stay (p = 0.006), the rate of non-unions at 6-month follow-up (p = 0.01).
Conclusion:
This study shows that in the management of open long bone fractures in low-resource settings, the use of local aqueous gentamycin administration as an adjunct to conventional management is effective in lowering the infection rates, reducing the number of operations, reducing length of hospital stay and non-union rates. Despite some methodological limitations, the authors hope the study contributes to the body of evidence for the use of topical antibiotics in the management of open fractures.

What will audience learn from your presentation?

• The audience will be able to learn the challenges in managing open fractures in a low-middle income country, and also learn that local aqueous gentamycin can be used as an adjunct to the conventional management of open fractures to lower infection rates.
• The main challenge for any orthopedic surgeon managing open fractures is post-operative complications especially osteomyelitis, delay bone union and non-union. The results of this research on the use of topical aqueous gentamycin as an adjunct to the conventional management of open fractures contributes to the body of evidence for the use of topical antibiotics. The study provides practical solutions in managing open fractures in low-middle income countries and with the well outlined limitations, other researchers can reproduce a similar study to add strength on the use of topical antibiotics as an adjunct to the conventional management of open fractures.

Biography:

Dr.Dickson Rollef Wak studied Bachelor in Medicine and Surgery (MMBS) at the University of Papua New Guinea from 2010 to 2014 and Graduated in 2015. He completed the Resident Medical Officer training in 2016. In 2017, was working as a general practitioner at Hela Province of Papua New Guinea (one of the remotest regions), from there, He developed the interest in Surgery and in 2018, Dickson joined the Surgical Department of Madang Provincial Hospital. In 2019, he commenced the research title “A Randomised Control Trial to Compare Topical Use of Antibiotic Versus Conventional Management of Open Fractures”; And was published on the 27^th April 2023 through the EChronicon Orthopedic Journal, UK. He have just passed my exams in Masters in General Surgery at the University of Papua New Guinea.