TOPLINE

Postoperative infection following volar locking plate fixation of closed distal radius fractures was extremely rare, with only one superficial infection identified among 474 consecutive patients over a 3-year period. Despite uniformly low infection rates, considerable variation in perioperative antibiotic prophylaxis practice was observed among surgeons.

METHODOLOGY

• This retrospective cohort study involved 474 adult patients (aged ≥ 18 years) who underwent volar locking plate fixation of closed distal radius fractures between January 2022 and December 2024.
• Of those included, 237 received perioperative antibiotic prophylaxis and 237 did not, based on surgeon preference. Prophylaxis comprised a single intravenous dose of flucloxacillin 2 g (or clindamycin 600 mg for penicillin allergy) given before skin incision.
• The study outcome was postoperative surgical site infection within 1 year of surgery, identified through systematic review of electronic medical records and classified as superficial or deep.
• The median follow-up duration was 29.3 months in the nonprophylaxis group and 26.8 months in the prophylaxis group.

TAKEAWAY

• The overall infection rate was 0.2%, with one superficial infection in the nonprophylaxis group (0.4%) and none in the prophylaxis group (0.0%).
• No deep infections or infection-related reoperations were identified during the 1-year follow-up period.
• Patients who received prophylaxis had higher American Society of Anesthesiologists (ASA) classes; for example, 16.5% were ASA class 3 vs 9.3% of those who did not receive prophylaxis.
• Prophylaxis was less common among more experienced surgeons; 19.8% of patients who received prophylaxis vs 36.7% of those who did not were treated by level 3 surgeons (P < .001 for overall distribution).

IN PRACTICE

"While the study was not powered to evaluate the effectiveness of antibiotic prophylaxis, it provides descriptive data on postoperative infection burden and current prophylaxis practice following volar locking plate fixation of closed distal radius fractures," the author of the study wrote.

SOURCE

The study was led by Daniel Muder, Uppsala University in Uppsala, Sweden. It was published online on October 3, 2026, in BMC Musculoskeletal Disorders.

LIMITATIONS

Because the study was retrospective, minor infections treated at other institutions may have gone unrecorded. The groups also differed at baseline, mainly in ASA class and surgeon experience, which restricted any conclusions about whether prophylaxis caused differences in outcomes. The groups could not be formally compared statistically because of the low number of infection events, and the study could not establish whether perioperative antibiotic prophylaxis alters the risk for postoperative infection.

DISCLOSURES

This study did not receive any specific funding from agencies in the public, commercial, or not-for-profit sectors. The author reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.