Session IX - Basic Science
Debridement of Cancellous Bone: A Comparison of Irrigation Methods
Purpose: Proper debridement and irrigation are essential in the management of open fractures. Recent studies have shown that irrigation with high pressure pulsatile lavage (HPPL) is deleterious to bone structure as well as fracture healing and is less efficacious than other irrigation methods for removing gross contaminants from soft-tissue wounds. This study compared HPPL, bulb syringe irrigation, and brush/suction irrigation in an in-vitro model regarding their efficacy at removing foreign material and their damage to cancellous bone.
Methods: Cancellous bone of bovine distal femurs was sawn into uniform-sized slices, scored in a latticed pattern, and divided into 8 test groups of 6 samples each. Four of the test groups were not contaminated and were treated as follows: no treatment (control), bulb irrigation, brush/suction irrigation, and HPPL. The other four test groups were contaminated with 1.0 g rock dust and treated with the same four methods. Runoff from the irrigation was collected, filtered, lyophilized, and ashed to allow for quantitative determination of organic and inorganic material removed from each sample. Samples were then blindly graded to qualitatively assess macroscopic tissue damage and irrigation method efficacy.
Results: Significantly more (P<0.05) organic material was removed from samples treated with HPPL (0.7448±0.4140 g) than with bulb syringe (0.1152±0.0413 g) or brush/suction irrigation (0.0951±0.0319 g). Brush/suction irrigation removed significantly more (P<0.05) of the 1.0 g of initial inorganic contaminant (0.9377±0.0148 g) than bulb syringe irrigation (0.8662±0.0737 g). It also removed more contaminant than HPPL (0.9002+/-0.0467 g); however, this was not by a statistically significant margin (P=0.090). Conversely, HPPL did not remove significantly more contaminant than bulb syringe irrigation (P=0.362).
Conclusion/Significance: These findings indicate that brush/suction irrigation removes contaminant as well as if not better thanHPPL, while causing significantly less damage to soft tissues within the bone structure. Even though samples treated with HPPL appeared cleaner than those treated with bulb syringe, HPPL did not remove statistically significantly more inorganic contaminant. HPPL may drive some contaminants deep into the tissue, rather than removing them, making HPPL not only more deleterious to bone structure and presumably healing, but also less efficacious at removing contaminant than brush/suction irrigation.