A randomised controlled trial comparing silver impregnated fibrous hydrocolloid dressings to silver sulfadiazine cream dressings for the treatment of fracture blisters to determine time to surgical readiness

OBJECTIVES To investigate, in patients suffering from fracture blisters, the time to surgical readiness in those treated with silver impregnated fibrous hydrocolloid (SFH) dressings compared to those treated with topical silver sulfadiazine (SS) cream, and to determine the direct costs associated with both treatments. DESIGNL A single-blind, randomised controlled trial. SETTING The study was conducted at Tygerberg Hospital, a tertiary care facility, and Worcester Provincial Hospital, a secondary care facility, Western Cape, South Africa. PATIENTS Patients >18 years, suffering from one or more fracture blisters overlying fractures requiring surgical fixation, were considered for inclusion. MAIN OUTCOME MEASUREMENTS The main outcome was the time to surgical readiness, following complete re-epithelialisation of the affected site, in both groups. The direct cost associated with each treatment and the daily cost associated with hospital stay per day was recorded. RESULTS At an interim-analysis 70 patients had been enrolled and completed the study protocol with 35 patients per group. Groups were balanced across patient and clinical demographic characteristics. A significant difference of 4 days (95%CI: 2.9-5.1 days, p<0.001) in the mean time to surgical readiness (SFH group, 5.3 days vs SS group, 9.3 days) was observed.. No difference between the time to surgical procedure as well as the total length of hospital stay between the two groups was observed. CONCLUSION This study reports that SFH dressings is a cost-effective treatment option for the management of fracture blisters evidenced by a significant accelerated time to blister re-epithelialisation compared to a commonly described method of SS cream dressings. LEVEL OF EVIDENCE Therapeutic Level 1. See Instructions for Authors for a complete description of levels of evidence.