Abstract
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.
Highlights
Surgeons acknowledge the importance of irrigating open fracture wounds, the choice of irrigating fluid and delivery pressure remains controversial
The items generated from the focus group were improved by data from a MEDLINE search of articles published from 1966 to 2006 using text words "irrigation," "debridement," "infection," "open fractures," "pressure," "antibacterial agents," "detergents," "soaps," "solutions," "disinfection," and "bacitracin." Further items were generated with key informants
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
Summary
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. Prevention of infection, stable fixation of the fractured bone and restoration of patient function remain paramount in the management of these complex injuries. Meticulous debridement of contaminated soft tissues along with copious fluid irrigation is regarded as the most important initial step in the surgical wound management of open fractures [2,4,8,9,10]. By 2020, disability from traffic accidents, the major cause of fractures is estimated to rank in the top 3 of all cause disability from disease. A vehicular accident is reported every three minutes and a death every ten minutes on Indian roads. 3 patients survive and live with disability
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