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The Journal of Bone and Joint Surgery 79:1590 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Andrew J. Kelly, F.R.C.S., Ian G. Winson, Thomas P. Knapp, M.D., Michael J. Patzakis, M.D., Jackson Lee, M.D., Peter R. Seipel, M.D., Karim Abdollahi, M.D. and Robert B. Reisch, M.D.

TO THE EDITOR:

We read with interest "Comparison of Intravenous and Oral Antibiotic Therapy in the Treatment of Fractures Caused by Low-Velocity Gunshots. A Prospective, Randomized Study of Infection Rates" (78-A: 1167–1171, Aug. 1996), by Knapp et al. The authors are to be congratulated on the prospective design and the rigorous follow-up, but two aspects of the method and their main conclusion require comment.

First, the main outcome measure is "a strict definition of infection," but that definition was not stated. We have shown that infection rates are substantially higher when assessed on clinical grounds than when a microbiological definition is used1. Second, the follow-up period for the assessment of infection was not stated. Osteomyelitis and infection around an implant can present long after an operation and after apparently uncomplicated healing of the wound. . . . [Full Text of this Article]


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