The significance of positive cultures from orthopedic fixation devices in the absence of clinical infection

Microbiologic samples for culture were obtained from 21 patients during elective removal of fracture-fixation hardware. The hardware was being removed for pain, displacement, nonunion or malunion correction, or patient preference. None of the patients had evidence of infection as determined by medical history, physical examination, white blood count, and sedimentation rate performed on the day of hardware removal. Two sets of culture samples were obtained from each patient: swabs of the wound and of the hardware were obtained and processed by the hospital laboratory. Eleven hardware cultures and nine wound cultures were positive for microbiologic growth. None of the patients was treated with antibiotics, and none developed any problems with wound infection or healing nor any evidence of osteomyelitis. We concluded that positive cultures obtained during hardware removal in the absence of clinical signs of infection are not meaningful.