Efficacy of primary wound cultures in long bone open extremity fractures: are they of any value?

The management of long bone open extremity fractures has included initial wound cultures, antibiotics, operative debridement, and fracture repair, if indicated. The value of initial wound cultures is unclear. We examined whether primary wound cultures predict which wounds will become infected, and whether bacterial growth on primary wound cultures correlates with bacteria cultured from infected wounds. This prospective study involved patients presenting to a regional trauma center. Before any interventions were performed, initial aerobic and anaerobic cultures of the wounds of 117 consecutive open extremity fractures grades I-III were obtained. The results of these cultures were correlated with the development of a wound infection, and if an infection occurred, the organism grown from the infected wound was compared with any organism grown from the primary wound cultures. Of the initial cultures, 76% (89/117) did not demonstrate any growth, while the other 24% (28/117) only grew skin flora. There were only 7 (6%) wound infections, and 71% (5/7) initially did not grow any organisms. Of the isolates that grew from the initial cultures, none were the organisms that eventually led to wound infections. The use of primary wound cultures in open extremity injuries has no value in the management of patients suffering long bone open extremity fractures.