THE SIGNIFICANCE OF A BACTERIOLOGICAL SWAB IN COMPOUND FRACTURES

Abstract

Compound fractures are a surgical emergency. The primary treatment is early operative debridement and stabilization of the bone. Debridement of a compound fracture includes exploration of the wound to define the injury, removal of devitalized tissue and the use of pulse lavage to achieve additional mechanical debridement of the wound. We could not find any study confirming the use of a pus swab in acute fractures. This study evaluates the significance of early pus swabs taken pre and post debridement of compound fractures in long bones.

Between January 2005 and March 2006, 50 patients with compound fractures of long bones were assessed. A detailed history, mechanism, time of injury, presentation to hospital and time taken for debridement were recorded. The fractures were classified according to Gustilo and Anderson. A pre-debridement washout and a pus swab was taken at presentation to the orthopaedic emergency room. All patients were given ATT and cephalosporin, and the limbs were splinted. All fractures were again irrigated and debrided and fracture stabilized in theatre. A second swab was taken and the time recorded.

There were 50 patients, 30 males with a mean age of 32 years. 15 Of the fractures were grade 1 compound, 13 grade 2, 10 grade 3A and 12 grade 3B. Cultures revealed 12 patients with staphylococcus, 10 with multiple organisms, and 28 patients with no growth in the pre-debridement group. In the post-debridement group staphylococci were cultured in 18 patients, there were multiple organisms present in 20 and no organisms in 12. Only 3 patients had their debridement within 6 hours of injury.

The timing of the colonization of the wound, the virulence and number of organisms and the immunological response of the patient’s vary. A combination of these factors will determine whether a compound fracture will be infected. Early wound infection has been found to be a poorer predictor of wound sepsis, hence the significance of a bacteriological swab. There is a relatively higher rate of wound infection following formal debridement as evidenced by the bacteriological cultures and is not related to the time of debridement.