Efficacy of topical vancomycin in preventing surgical site infection following fracture surgery

This meta-analysis pooled five randomized trials (1,373 patients) comparing intraoperative topical vancomycin powder plus standard IV antibiotics versus IV antibiotics alone for preventing fracture-related infection (FRI) after limb fracture surgery. Pooled results showed a significant reduction in FRI with vancomycin powder (RR 0.64, 95% CI 0.43-0.96, p=0.030), driven largely by fewer gram-positive infections, while no individual trial or fracture subgroup (closed fixation, arthroplasty, open fracture) reached significance on its own. No differences were found in superficial SSI, nonunion, wound healing complications, or nephrotoxicity.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersTopical vancomycin powder is increasingly used off-label in fracture surgery, so clerkship students should know the current evidence is a modest, fragile pooled signal rather than a settled practice.

Presenting this at rounds? Start here

• ?If topical vancomycin only reduces gram-positive FRI without affecting gram-negative infection, should surgeons combine it with another agent in open fractures where gram-negative organisms are common?
• ?Given the lack of significance in any single trial or fracture subgroup, should surgeons wait for a definitive RCT before adopting topical vancomycin routinely in closed fracture fixation or arthroplasty?