PPAK: Do peri-operative prophylactic antibiotics reduce pin-site infection after K-wire application in closed fractures? An international prospective observational study

Introduction: The role of peri-operative prophylactic antibiotics in preventing pin-site infection following percutaneous K-wire fixation of closed fractures remains unclear, and existing guidance does not specifically address this procedure. This study evaluated whether prophylactic antibiotics reduce infection risk following K-wire fixation of distal radius and paediatric supracondylar fractures. Methods: An international, multicentre, prospective observational study was conducted across 30 hospitals in three countries (United Kingdom, Spain and Greece) between December 2023 and October 2024. Adults with distal radius fractures and children with supracondylar elbow fractures managed using percutaneous K-wire fixation were included. Data on patient factors, operative care and antibiotic use were recorded. The primary outcome was surgical site infection (SSI) occurring up to two weeks post K- wire removal. Results: Of 397 submitted cases, 394 were analysed; SSI outcome data were available for 384/394 (97.5%). Peri-operative prophylactic antibiotics were administered in 342/394 (86.8%). Nine SSIs occurred overall (9/384; 2.3%) with similar incidence in antibiotic and non-antibiotic groups (8/333 [2.4%] vs 1/51 [2.0%]; p = 1.000). Infections were predominantly low grade and managed with oral antibiotics and/or K-wire removal. Kaplan–Meier analysis demonstrated no divergence in time-to- infection between groups. Conclusion: Peri-operative prophylactic antibiotics did not demonstrate a reduction in SSI following percutaneous K-wire fixation of closed distal radius and paediatric supracondylar fractures. These findings support reconsideration of routine prophylaxis in this setting, aligned with antimicrobial stewardship.