Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures

Museru, Lawrence; Kumar, Akash; Ickler, P.

doi:10.1007/bf00268044

Cited by 30 publications

(21 citation statements)

References 4 publications

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“…Initial irrigation, if done in the first 6 hours after injury, was accomplished by gravity inflow and brush (Level 2). 17 After 6 hours, pulsatile lavage was used (Level 5). No antibiotics or soap were added to the irrigation solution (Level 1).…”

Section: Establishment Of Institution Protocolmentioning

confidence: 99%

Attempting primary closure for all open fractures: the effectiveness of an institutional protocol

et al. 2014

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Background: Immediate primary closure of open fractures has been historically believed to increase the risk of wound infection and fracture nonunion. Recent literature has challenged this belief, but uncertainty remains as to whether primary closure can be used as routine practice. This study evaluates the impact of an institutional protocol mandating primary closure for all open fractures. Methods:We retrospectively reviewed all open fractures treated in a single level 1 trauma centre in a 5-year period. Prior to the study, a protocol was adopted standardizing management of open fractures and advocating primary closure of all wounds as a necessary goal of operative treatment. Patient and fracture characteristics, type of wound closure and development of infectious and bone healing complications were evaluated from time of injury to completion of outpatient follow-up. Contexte : On a de tout temps cru que la fermeture primaire immédiate des fractures ouvertes accroissait le risque d'infection de la plaie et de non soudure osseuse. La littérature récente remet cette position en question, mais on ignore encore si la fermeture primaire peut être utilisée de routine. Cette étude évalue l'impact d'un protocole d'établissement imposant la fermeture primaire de toutes les fractures ouvertes. ResultsMéthodes : Nous avons passé en revue de manière rétrospective toutes les fractures ouvertes traitées dans un seul centre de traumatologie de Niveau 1 au cours d'une période de 5 ans. Avant l'étude, un protocole a été adopté pour standardiser la prise en charge des fractures ouvertes et promouvoir la fermeture primaire de toutes les plaies comme objectif imposé du traitement opératoire. Les caractéristiques des patients et des fractures, les types de fermeture de plaie et les complications infectieuses ou liées à la guérison osseuse ont été évalués à partir du moment de la blessure et jusqu'à la fin du suivi en clinique externe.Résultats : En tout, 297 fractures ouvertes ont été traitées, 255 d'entre elles (85,8 %), au moyen d'une fermeture primaire immédiate. Les traumatismes ouverts de Type III comptaient pour 24 % de toutes les blessures. Les plaies qui ont été refermées immé-diatement ont présenté un taux d'infection superficielle de 11 % et un taux d'infection profonde de 4,7 %. Ces 2 proportions sont équivalentes ou inférieures à ce qui a été observé chez les témoins historiques chez qui la fermeture de plaie a été reportée. La classification des fractures, la vitesse de l'impact à l'origine des traumatismes et le temps écoulé avant la fermeture des plaies n'ont pas été en corrélation significative avec l'infection et le retard de soudure osseuse ou la non soudure osseuse. Conclusion :Tenter d'appliquer une fermeture primaire à toutes les fractures ouvertes est une pratique sécuritaire et efficace qui n'accroît pas le risque d'infection postopératoire, de retard de soudure osseuse ou de non soudure osseuse.

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Section: Establishment Of Institution Protocolmentioning

confidence: 99%

Attempting primary closure for all open fractures: the effectiveness of an institutional protocol

et al. 2014

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“…There is a paucity of clinical trials evaluating open fracture wounds. Museru et al, conducted a randomized controlled trial comparing isotonic saline, distilled water and boiled water in the irrigation of open fracture wounds[ 33 ]. They reported an infection rate of 35% in the isotonic saline group, 17% in the distilled water group and 29% in the boiled water group.…”

Section: Discussionmentioning

confidence: 99%

Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons

Petrisor

Jeray

Schemitsch

et al. 2008

BMC Musculoskelet Disord

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BackgroundAlthough surgeons acknowledge the importance of irrigating open fracture wounds, the choice of irrigating fluid and delivery pressure remains controversial. Our objective was to clarify current opinion with regard to the irrigation of open fracture wounds.MethodsWe used a cross-sectional survey and a sample-to-redundancy strategy to examine surgeons' preferences in the initial management of open fracture wounds. We mailed this survey to members of the Canadian Orthopaedic Association and delivered it to attendees of an international fracture course (AO, Davos, Switzerland).ResultsOf the 1,764 surgeons who received the questionnaire, 984 (55.8%) responded. In the management of open wounds, the majority of surgeons surveyed, 676 (70.5%), favoured normal saline alone. Bacitracin solution was used routinely by only 161 surgeons (16.8%). The majority of surgeons, 695 (71%) used low pressures when delivering the irrigating solution to the wound. There was, however considerable variation in what pressures constituted high versus low pressure lavage. The overwhelming majority of surgeons, 889 (94.2%), reported they would change their practice if a large randomized controlled trial showed a clear benefit of an irrigating solution – especially if it was different from the solution they used.ConclusionThe majority of surgeons favour both normal saline and low pressure lavage for the initial management of open fracture wounds. However, opinions varied as regards the comparative efficacy of different solutions, the use of additives and high versus low pressure. Surgeons have expressed considerable support for a trial evaluating both irrigating solutions and pressures.

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“…While bacteria and residual materials can be removed by lavaging with pressure, caution is needed as excessive pressure damages granulation tissue on the wound surface. It is recommended to warm lavage fluid nearly to the body temperature . Cold lavage fluid should be avoided, because it not only is less effective for removing contamination but also may cause vasoconstriction in diabetic ulcer, angiitis and ulcers associated with collagen disease.…”

Section: Commentarymentioning

confidence: 99%

“…It is recommended to warm lavage fluid nearly to the body temperature. 59 Cold lavage fluid should be avoided, because it not only is less effective for removing contamination but also may cause vasoconstriction in diabetic ulcer, angiitis and ulcers associated with collagen disease. If, on the other hand, lavage fluid is warmed excessively, it may denature protein on the wound surface.…”

Section: Significance Of Lavage and Points Of Cautionmentioning

confidence: 99%

The wound/burn guidelines – 1: Wounds in general

Inoue

Hasegawa

Maekawa

et al. 2016

The Journal of Dermatology

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Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures

Cited by 30 publications

References 4 publications

Attempting primary closure for all open fractures: the effectiveness of an institutional protocol

Attempting primary closure for all open fractures: the effectiveness of an institutional protocol

Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons

The wound/burn guidelines – 1: Wounds in general

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