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Effect of Gentamicin Addition to Normal Saline on Microbial Contamination and Early Wound Infection of Open Tibial Fractures

DOI: 10.4236/oalib.1111686, PP. 1-11

Subject Areas: Orthopedics

Keywords: Wound Irrigation, Bacteria Colony Counts, Open Fractures, Wound Infection, Gustillo-Anderson Classification

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Background: Infections continue to pose a significant challenge in the management of open tibia fractures, and the role of antibiotics in irrigation fluid remains unclear. Objectives: This study aimed to compare the pre- and post-irrigation bacteria colony counts of open tibia fractures in two irrigation groups: Normal Saline Fluid (NSF) and Normal Saline with Gentamicin (NSG). Patients and Methods: Fifty patients with Gustillo-Anderson I and II open tibia fractures were randomly assigned to either the NSF or NSG group. Pre-irrigation wound swabs were taken before randomization. Post-irrigation samples were collected, and patients were monitored weekly using the SOUTH-AMPTON grading system for six weeks. Patients with clinical wound infection underwent wound culture. Results: Motor cycle injuries accounted for 56% of patients, with a modal age of 20 - 40 years and 75% male. Before irrigation debridement, the bacteria colony counts (BCC) were 20,056 ± 9600 cfu/ml and 22,456 ± 21,150 cfu/ml for NSF and NSG groups, respectively (p = 0.608). Post-irrigation, the BCC decreased to 8892 ± 4830 cfu/ml in the NSF group and 256 ± 341 cfu/ml in the NSG group (p < 0.0001). Seven (28%) NSF patients developed wound infection, primarily with staphylococcus, while none of the NSG patients were infected. Conclusion: Irrigation of open tibia fractures with normal saline impregnated with gentamicin fluid appears to reduce bacterial count load and early wound infection.

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Oyagbesan, O. S. , Adegbehingbe, O. O. and Esan, O. (2024). Effect of Gentamicin Addition to Normal Saline on Microbial Contamination and Early Wound Infection of Open Tibial Fractures. Open Access Library Journal, 11, e1686. doi:


[1]  Gustilo, R.B., Mendoza, R.M. and Williams, D.N. (1984) Problems in the Man-agement of Type III (severe) Open Fractures. The Journal of Trauma: Injury, In-fection, and Critical Care, 24, 742-746.
[2]  Patzakis, M.J. and Wil-kins, J. (1989) Factors Influencing Infection Rate in Open Fracture Wounds. Clin-ical Orthopaedics and Related Research, 243, 36-40.
[3]  Doshi, P., Gopalan, H., Sprague, S., Pradhan, C., Kulkarni, S. and Bhandari, M. (2017) Incidence of In-fection Following Internal Fixation of Open and Closed Tibia Fractures in India (INFINITI): A Multi-Centre Observational Cohort Study. BMC Musculoskeletal Disorders, 18, Article No. 156.
[4]  Jorge-Mora, A., Amhaz-Escanlar, S., Ivan, C.G., Lopez-DelTeso, C., Gomez, R., et al. (2018) Management of Open Fracture. In: Ozgur, K. and Hakan, T., Eds., Trauma Surgery, IntechOpen, 11.
[5]  Gabriel, A., Erik, D. and Schraga, M.D. (2017) Wound Irrigation Updated.
[6]  Rosenstein, B.D., Wilson, F.C. and Funderburk, C.H. (1989) The Use of Bacitracin Irrigation to Prevent Infection in Postoperative Skeletal Wounds: An Experimental Study. The Journal of Bone & Joint Surgery, 71, 427-430.
[7]  Conroy, B.P., Anglen, J.O., Simpson, W.A., Christensen, G., Phaup, G., Yeager, R., et al. (1999) Com-parison of Castile Soap, Benzalkonium Chloride, and Bacitracin as Irrigation Solu-tions for Complex Contaminated Orthopaedic Wounds. Journal of Orthopaedic Trauma, 13, 332-337.
[8]  Halasz, N.A. (1977) Wound Infection and Topical Antibiotics. Archives of Surgery, 112, 1240-1244.
[9]  Lord, J.W., Rossi, G. and Daliana, M. (1977) Intraoperative Antibiotic Wound Lavage. Annals of Surgery, 185, 634-641.
[10]  Court-Brown, C.M., Rimmer, S., Prakash, U. and McQueen, M.M. (1998) The Epidemiology of Open Long Bone Fractures. Injury, 29, 529-534.
[11]  Ibeanusi, S. and Ekere, A. (2007) Epidemiology of Open Tibial Fractures in a Teaching Hospital. Port Har-court Medical Journal, 1, 156-160.
[12]  Ikem, I., Oginni, L. and Bam-gboye, E. (2001) Open Fractures of the Lower Limb in Nigeria. International Or-thopaedics, 25, 386-388.
[13]  Werner, C.M.L., Pierpont, Y. and Pollak, A.N. (2008) The Urgency of Surgical Débridement in the Management of Open Fractures. Journal of the American Academy of Or-thopaedic Surgeons, 16, 369-375.
[14]  Schenker, M.L., Yan-nascoli, S., Baldwin, K.D., Ahn, J. and Mehta, S. (2012) Does Timing to Operative Debridement Affect Infectious Complications in Open Long-Bone Fractures? Journal of Bone and Joint Surgery, 94, 1057-1064.
[15]  Nanchahal, J., Nayagam, S., Khan, U., Moran, C., Barrett, S., Sanderson, F. and Palliister, I. (2009) Standard for the management of Open Fractures of the Lower Limb. Reviewed by British Associa-tion of Plastic, Reconstructive and Aesthetic Surgeons. Royal Society of Medicine Press Ltd.
[16]  British Orthopaedic Association and the British Association of Plastic (2018) Reconstructive, Aesthetic Surgeons. Standard for Trauma—2009. BOAST 4: The Management of Severe Open Lower Limb Fractures.
[17]  Chang, Y., Bhandari, M., Zhu, K.L., Mirza, R.D., Ren, M., Kennedy, S.A., et al. (2019) Antibiotic Prophylaxis in the Management of Open Fractures. JBJS Reviews, 7, e1.
[18]  Böstman, O. (1983) Morphological Observations of Torsional Fractures of the Adult Tibial Shaft. Acta Orthopaedica Scandinavica, 54, 627-633.
[19]  Swiontkowski, M. and Cross III, W. (2008) Treatment Principles in the Management of Open Fractures. Indian Journal of Orthopaedics, 42, 377-386.
[20]  Gustilo, R. and Anderson, J. (1976) Prevention of Infection in the Treatment of One Thousand and Twenty-Five Open Fractures of Long Bones. The Journal of Bone & Joint Surgery, 58, 453-458.
[21]  Sitati, F.C., Mosi, P.O. and Mwangi, J.C. (2018) Early Bacterial Cultures from Open Frac-tures—Differences before and after Debridement. Annals of African Surgery, 14, 66-70.
[22]  Agarwal, D., Maheshwari, R., Agrawal, A., Chauhan, V. and Juyal, A. (2015) To Study the Pattern of Bacterial Isolates in Open Fractures. Journal of Orthopedics, Traumatology and Rehabilita-tion, 8, 1-5.
[23]  Ojo, O.D., Oluwadi-ya, K.S., Ikem, I.C., Oginni, L.M., Ako-Nai, A.K. and Daniel, F.V. (2010) Super-ficial Swab Cultures in Open Fracture Management: Insights from a Resource-Poor Setting. Journal of Wound Care, 19, 432-438.
[24]  Ikem, I.C., Oginni, L.M., Bamgboye, E.A., Ako-Nai, A.K. and Onipede, A.O. (2004) The Bacteriology of Open Fractures in Ile-Ife, Nigeria. Nigerian Journal of Medicine, 13, 359-365.
[25]  Glotzer, D.J. (1970) Topical Antibiotic Prophylaxis in Contaminated Wounds. Archives of Surgery, 100, 589-593.
[26]  Abu Hanifah, Y. (1990) Post-Operative Surgical Wound Infection. Medical Journal of Malaysia, 45, 293-297.
[27]  D’Souza, A., Rajagopalan, N. and Amaravati, R. (2008) The Use of Qualitative Cultures for Detecting Infection in Open Tibial Fractures. Journal of Orthopaedic Surgery, 16, 175-178.


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