Journal List > J Korean Foot Ankle Soc > v.18(2) > 1043334

J Korean Foot Ankle Soc. 2014 Jun;18(2):68-71. Korean.
Published online June 09, 2014.
Copyright © 2014 The Korean Foot and Ankle Society. All rights reserved.
Results of Culture Test at the Time of Removal of Metal Implants Used for Ankle Fracture Management
Hyung-Jin Chung, Su-Young Bae, and Jae-Ha Yu
Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Corresponding Author: Su-Young Bae. Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. Tel: 82-2-950-1399, Fax: 82-2-950-1398, Email:
Received March 29, 2014; Revised April 28, 2014; Accepted April 28, 2014.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The purpose of this study is to report the results of culture test at the time of removal of metal devices used for management of ankle fractures and for analysis of contributing factors.

Materials and Methods

We reviewed medical records of 132 patients with lower tibia and ankle fracture who had their metal devices removed during the period from January 2010 to February 2014. Patients with clinical signs of infection were excluded. Culture test was performed by taking the granulation tissue around the metal device at the time of removal. We divided the subjects into two groups, culture positive and negative. We then performed a retrospective review of each medical record of multiple factors that might contribute to the culture results, including laboratory results, medical history, material and size of metal device, indwelling period, and whether or not it was open injury.


Among 132 cases, six were culture positive. Enterococcus was detected in two cases and the others were Staphylococcus. No significant difference in medical history of patients and laboratory results, including C-reactive protein level, was observed between the culture positive and negative group. Culture positive rate was 5.4% in titanium and 3.9% in stainless steel. In terms of metal size, culture positive rate was 5.1% in small plates, 6.7% in large plates, and culture negative in intramedullary nails. The average indwelling period of metal device was 61.5 weeks in the culture positive group, and 68.6 weeks in the negative group. Nine cases were open fractures and all were in the culture negative group.


Whether or not the culture result was positive, there were no meaningful contributing factors. Presence of bacterium on the metal device could not be screened by any laboratory results or other factors.

Keywords: Ankle; Fracture; Metal device; Removal; Culture test


Figure 1
Clinical photographs show thick granulation tissue around (A) and at under surface (B) of the metal device during the removal.
Click for larger image


Table 1
Laboratory Results of Two Groups
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Table 2
Co-morbid Conditions of Two Groups
Click for larger image

Table 3
Characteristics According to the Metal Devices
Click for larger image

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