The use of sulfonamides in the treatment of compound fractures

Abstract

s INCE the introduction of the sulfonamides, hope has been entertained by many that by their use the incidence of infection in accidental wounds could be materially lessened. With few exceptions the oral administration of the sulfonamide group proved disappointing in the control of infection in compound fractures and its use was discontinued by most surgeons. The advantages of local implantation of powdered sulfanilamide in the wound was first brought to our attention by Jensen, Johnsrud, and Nelson, in 1939. They demonstrated, both clinically and experimentally, that the incidence of infection in contaminated wounds could be reduced materially by the iniroduction of sulfanilamide powder in the wound. They again emphasized the fact that the sulfonamides were a bacterio,static and not a bactericidal agent and that in order to control infection in contaminated wounds it was necessary to have a higher concentration of the drug locally than could be obtained by oral administration. The local implantation of the drug in amounts of from 5 to 15 Gm. resulted in concentrations as high as 800 mg. per cent, which they felt was the factor in combating the infection locally. Following this report a large number of articles appeared in the literature relative-to the merits or demerits of this method of treatment in clinical cases. By far the majority of surgeons reporting on this were enthusiastic over the results obtained, although very few carried out or reported a control series. It is a difficult task to evaluate results accurately in the treatment of compound fractures unless we know all the facts pertaining thereto, such as the severity of the fracture, time seen after the accident, whether a dirty or clean wound, etc. Perhaps some of the discrepancies in the results obtained in different centers are due, in large part, to the difference in the local conditions. Prior to the use of sulfanilamide, the general infection rate with compound fractures at the Minnesota General Hospital ran from 25 to 28 per cent and this was reduced to 4.9 per cent following the use of sulfanilamide locally. At the Henry Ford Hospital the infection rate with compound fractures in 1938 was 20 per cent, and in 1939 it was 15.4 per cent. Since the use of .sulfanilamide the rate has been reduced to 9.7 per cent. A few of the reported results of treatment of compound fractures with local implantation of sulfanilamide are shown in Table I. Of those reporting, Campbell in particular questioned the efficacy of the drug but stated that further study and a larger number of cases would be necessary before a final conclusion could be reached.