Abstract
Objective To confirm the role of X-ray exposure in treating infected wound fractures at the lower limb and determine X-ray exposure times. Methods Fifty-one wound swabs were collected from patients with infected open fractures at the lower limb with grade II, IIIA, B, and C according to the Gustilo and Anderson classification system and then cultured. The bacterial isolates were identified by biochemical tests and the VITEK-2 System and tested against several antibiotics. The X-ray exposure was done for open fractures by radiography (at kV133 and 5 milliambers). Results The higher isolation rate was recorded for Staphylococcus aureus with 21 (41.2%) isolates, and most of them (20, 95.2%) were isolated from grade II fractures. The isolation rate of Gram-negative bacteria was 25.5% for Escherichia coli with 13 isolates, 19.6% for Pseudomonas aeruginosa with 10 isolates, and 13.7% for Klebsiella pneumoniae with 7 isolates, most of which were isolated from grade III fractures. The isolation rate of P. aeruginosa was 60% (6 isolates) from grade IIIA and 71.4% (5 isolates) from grade IIIB for K. pneumoniae, while for E. coli it was 69.2% (9 isolates) from grade IIIC. All the bacterial isolates recorded high levels of antibiotic resistance against most tested antibiotics. Wound cultures of grade II fractures appeared sterile after the first X-ray exposure, and these wounds were infected with S. aureus or P. aeruginosa. However, cultures of grade IIIA and IIIB fractures appeared sterile after the second X-ray exposure for all isolated bacteria, except for S. aureus (grade IIIA fractures) (after the third X-ray exposure). Grade IIIC fractures showed sterile culture after the third X-ray exposure for wounds infected with P. aeruginosa and E. coli. Conclusions The study concluded that X-ray exposure showed high effectiveness in treating infected open fractures.
Highlights
An open fracture refers to a break in the skin, which is exposed to microbial contamination and eventually leads to most complicated infections
The incidence of open fractures recorded as 11.5 per 100 000 persons and >70% involve the lower limb [5]. e severity of open fractures was classified according to the Gustilo and Anderson classification as grades I, II, and III, and grade III was subclassified into IIIA, IIIB, and IIIC depending on the extent of contamination and the degree of soft tissue damage [6]
Fifty-one wound swabs were collected from patients with severe inflamed open fractures following fixation management. ese wound swabs were cultured on blood agar and MacConkey agar media. e severity of these wound fractures was classified into grade II and grade IIIA, B, and C according to the Gustilo and Anderson classification [6]. ey were located at the lower limb of patients admitted (Dowaly Private Hospital) during the period from February 2017 to September 2018
Summary
An open fracture refers to a break in the skin, which is exposed to microbial contamination and eventually leads to most complicated infections. Fifty-one wound swabs were collected from patients with infected open fractures at the lower limb with grade II, IIIA, B, and C according to the Gustilo and Anderson classification system and cultured. Wound cultures of grade II fractures appeared sterile after the first X-ray exposure, and these wounds were infected with S. aureus or P. aeruginosa. Cultures of grade IIIA and IIIB fractures appeared sterile after the second X-ray exposure for all isolated bacteria, except for S. aureus (grade IIIA fractures) (after the third X-ray exposure). Grade IIIC fractures showed sterile culture after the third X-ray exposure for wounds infected with P. aeruginosa and E. coli. An open fracture refers to one type of injury where there is a break in the skin and soft tissue, resulting in the exposure of the fractured bone to the external environment [1], leading to an increase in the eventuality of microbial contamination. Treating open fractures became very difficult, and choosing another role in treating became necessary
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