Prospective randomised controlled trials (RCTs), or quasi RCTs were eligible if they compared a single preoperative prophylactic dose of antibiotic with a multiple-dose perioperative strategy for the treatment of closed long bone fractures using internal surgical fixation or arthroplasty. Trials of open fractures were excluded. Eligible trials had to report the primary outcome of wound infection.
All fracture types or hip fractures were assessed in the included trials. Included trials evaluated the following antibiotics: cefazolin, cefamandole, cefonicid, cefotaxime, ceftazidime, ceftizoxime, ceftriaxone and cefuroxime; dosing schedules and half-lives varied. Trials compared single-dose regimens with multi-dose regimens, mostly consisting of three or more doses every eight hours. The mean age of participants ranged from 26 to 77 years; just under two-thirds of patients were female.
Two reviewers independently selected potential studies and three reviewers independently selected studies for inclusion in the review .