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

*Corresponding author: Mohamed A. Abdi, Vidmi T. Martin, Sayid O. Mohamed, Zhaozhen Wang, Leila E. Abdulle and Bo Yu*

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systematic review

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 six-hour 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 post-debridement.

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.

Keywords

Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.