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The following is a summary of “Skin Antisepsis before Surgical Fixation of Extremity Fractures,” published in the February 2024 issue of Infectious Diseases by Sprague et al.

Researchers conducted a retrospective study to assess the efficacy of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate for skin antisepsis before extremity fracture surgery in preventing surgical-site infections.

They conducted a crossover trial across 25 hospitals in the United States and Canada, assigning hospitals randomly to utilize either a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) for preoperative skin antisepsis in extremity fracture repair surgeries. Interventions alternated every 2 months. Patients with open or closed fractures were enrolled and analyzed separately. The primary outcome, surgical-site infection, encompassed superficial incisional infections within 30 days or deep incisional or organ-space infections within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications.

The results showed that in 6785 patients with closed fractures, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (OR, 0.74; 95% CI, 0.55 to 1.00; P=0.049). Among 1700 patients with open fractures, 

surgical-site infection occurred in 54 patients (6.5%) in the iodine group and 60 patients (7.3%) in the chlorhexidine group (OR, 0.86; 95% CI, 0.58 to 1.27; P=0.45). Frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar between the two groups.

Investigators concluded that for closed fractures, iodine povacrylex in alcohol reduces surgical-site infections compared to chlorhexidine gluconate, but both perform similarly for open fractures.

Source: nejm.org/doi/full/10.1056/NEJMoa2307679