Frequency of Micro-Organisms Isolated from Culture Reports of Extremities’ Open Fractures

Abstract

Introduction: Open fractures still represent a major challenge for the treating surgeon and frequently demand an array of complex procedures to achieve an undisturbed healing with adequate limb function. The incidence of infection in open fractures varies considerably in the literature. Spencer et al. [1] showed an overall incidence of infection in open fractures to be about 10.4% whereas Weitz-Marshall and Bosse found infection rates between 0% and 50%. Objective: To determine the frequency of micro-organisms from culture reports of open fractures of extremities. Materials and Methods: This was a Descriptive cross-sectional study conducted at Department of Orthopedic Surgery, Lady Reading Hospital, Peshawar in which a total of 162 presented with open fracture having duration of fracture more than 5 days. Duration of study was 06 months. Total sample size were162 keeping 12%5 proportion of E.Coli in open fractures with 95% confidence Interval, 5% level of significance and 5% margin of error calculated on WHO Sample Size Calculator. The sample technique was Consecutive non-probability sampling. Results: Age distribution among 162 patients was analyzed: 18-25 Years was 31 (19.1%) 26-30 Years was 27(16.6%) and 31-35 Years was 23(14.1%) 36-40 Years was 21(12.9%) 41-45 Years was 20(12,3%) 46-50 Years was 20(12,3%) and 50-60 Years was 20(12.3%). Mean age was 27.23 ± 3. Gender Wise Distribution among 162 patients was analyzed as 88 (54.3%) was Male and 74(45.6%) was Female. Distribution of compound fractures according to anatomic location among 162 Patients was analysed as tibia was 74, femur was 23, ankle was 18, hand and forearm was 14 and Arm was 15 patients. Micro-organisms distribution among 162 patients was analyzed as Staphylococcus aureus was 43(26.8%) Streptococcus was 34(20.9%) Staphylococcus epidermidis was 35(21.6%) E.Coli was 26(16.0%) and Enterobacter aerogenes 24(14.8%). Distribution of compound fractures according to Gustilo classification among 162 patients was analyzed as Grade1 was 27 Grade II was 42 Grade III was 75 Grade IIIB was 5 and Grade IIIC was 5. Conclusion: All Gustilo type II and type III open fractures, reached to the hospital in more than 6 hours should be considered infected. Wound should be properly washed, and specimen taken for culture and sensitivity. The patient should be started on intravenous first-generation cephalosporin and Aminoglycosides to cover both Gram-positive and Gram-negative organisms, till the availability of the culture and sensitivity reports.

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