Pre-Debridement and Post-Debridement Culture in Open Fractures of the Extremities: A Comparative Study

Abstract

Background
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived 
from such fracture sites.
Methods
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and 
retrieval system online (MEDLINE) and different citations provided the relevant data.
Results
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the sixhour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use 
of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected 
patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. 
Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for postdebridement.
Conclusion
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time 
interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious 
material and thereby reduces the infection rate.