Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection

Rabah Qadir, Timothy Costales, Max Coale, Alexandra Mulliken, Timothy Zerhusen, Manjari Joshi, Renan C. Castillo, Anthony R. Carlini, Robert V. O’Toole

Research output: Contribution to journalReview articlepeer-review


Objectives: To determine if the use of intrawound vancomycin powder reduces surgical-site infection after open reduction and internal fixation of bicondylar tibial plateau, tibial pilon, and calcaneus fractures. Design: Retrospective analysis. Setting: Level I trauma center. Patients: All fractures operatively treated from January 2011 to February 2015 were reviewed; 583 high-risk fractures were included, of which 35 received topical vancomycin powder. A previously published prospectively collected cohort of 235 similar high-risk fractures treated at our center from 2007 through 2010 served as a second comparison group. Intervention: Topical vancomycin powder at wound closure. Main Outcome Measurements: Deep surgical-site infection. Analyses used both univariate comparison of all patients and 1:2 matching analysis using both nearest neighbor and propensity-based matching. Results: Compared with a control group of fractures treated during the same time period without vancomycin powder, the infection rate with vancomycin powder was significantly lower [0% (0/35) vs. 10.6% (58/548), P = 0.04]. Compared with our previously published historical infection rate of 13% for these injuries, vancomycin powder was also associated with significantly decreased deep surgical-site infection (0% vs. 13%, P = 0.02). These results agreed with the matched analyses, which also showed lower infection in the vancomycin powder group (0% vs. 11%–16%, P ≤ 0.05). Conclusions: Vancomycin powder may play a role in lowering surgical-site infection rates after fracture fixation. A larger randomized controlled trial is needed to validate our findings.

Original languageEnglish (US)
Pages (from-to)23-28
Number of pages6
JournalJournal of orthopaedic trauma
Issue number1
StatePublished - Jan 1 2021


  • calcaneus fracture
  • deep infection
  • surgical-site infection
  • tibial pilon fracture
  • tibial plateau fracture
  • vancomycin powder

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Vancomycin Powder Use in Fractures at High Risk of Surgical Site Infection'. Together they form a unique fingerprint.

Cite this