Antibiotic use and kirschner wire fixation in forefoot surgery: A national survey

In foot and ankle patients, the use of Kirschner wires is common, and the population in the typical foot and ankle practice has higher rates of comorbidities associated with infection. This study assessed national trends regarding the use of postoperative prophylactic antibiotic therapy in patients undergoing foot and ankle surgery treated with percutaneous Kirschner wires. Attending physicians at foot and ankle fellowships were mailed a questionnaire that included 3 clinical vignettes containing questions on the use of postoperative antibiotics in patients treated with percutaneous Kirschner wires. A total of 112 physicians were identified; 64 physicians (57%) returned the survey. In the first case of a nondiabetic patient, 16 physicians (25%) indicated they would place the patient on postoperative antibiotics for an average of 9.4 days with an average duration of Kirschner wire fixation of 35.1 days. In the second case of a nonneuropathic diabetic patient, 18 surgeons (28%) indicated they would place the patient on postoperative antibiotics for an average of 13.8 days with an average duration of Kirschner wire fixation of 35.4 days. In the third case of a diabetic patient with neuropathy, 19 physicians (32%) indicated they would place the patient on postoperative antibiotics for an average of 14.5 days with an average duration of Kirschner wire fixation of 36.7 days. Few attending physicians at orthopedic foot and ankle fellowships placed their patients treated with percutaneous Kirschner wires on postoperative antibiotic prophylaxis, even in diabetic patients for whom an increased risk of infection has been documented.