| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Dr. Anglen is Associate Professor of Orthopaedic Surgery, University of Missouri-Columbia, Columbia.
Reprint requests: Dr. Anglen, University of Missouri-Columbia, One Hospital Drive, MC213, Columbia, MO 65212.
Wound irrigation to remove debris and lessen bacterial contamination is an essential component of open fracture care. However, considerable practice variation exists in the details of technique. Volume is an important factor; increased volume improves wound cleansing to a point, but the optimal volume is unknown. High-pressure flow has been shown to remove more bacteria and debris and to lower the rate of wound infection compared with low-pressure irrigation, although recent in vitro and animal studies suggest that it may also damage bone. Pulsatile flow has not been demonstrated to increase efficacy. Antiseptic additives can kill bacteria in the wound, but host-tissue toxicities limit their use. Animal and clinical studies of the use of antiseptics in contaminated wounds have yielded conflicting outcomes. Antibiotic irrigation has been effective in experimental studies in some types of animal wounds, but human clinical data are unconvincing due to poor study design. There are few animal or clinical studies of musculoskeletal wounds. Detergent irrigation aims to remove, rather than kill, bacteria and has shown promise in animal models of the complex contaminated musculoskeletal wound.
This article has been cited by other articles:
|
|
 |
|
  B. D. Owens, D. W. White, and J. C. Wenke Comparison of Irrigation Solutions and Devices in a Contaminated Musculoskeletal Wound Survival Model J. Bone Joint Surg. Am., January 1, 2009; 91(1): 92 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Prokuski Prophylactic Antibiotics in Orthopaedic Surgery J. Am. Acad. Ortho. Surg., May 1, 2008; 16(5): 283 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. D. Owens and J. C. Wenke Early Wound Irrigation Improves the Ability to Remove Bacteria J. Bone Joint Surg. Am., August 1, 2007; 89(8): 1723 - 1726. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Fletcher, D. Sofianos, M. B. Berkes, and W. T. Obremskey Prevention of Perioperative Infection J. Bone Joint Surg. Am., July 1, 2007; 89(7): 1605 - 1618. [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Crowley, N. K. Kanakaris, and P. V. Giannoudis Irrigation of the wounds in open fractures J Bone Joint Surg Br, May 1, 2007; 89-B(5): 580 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Whitfield and J.P. Garner The early management of gunshot wounds Part II: the abdomen, extremities and special situations Trauma, January 1, 2007; 9(1): 47 - 71. [Abstract] [PDF]
|
|
|
|
|
|
K. Okike and T. Bhattacharyya Trends in the Management of Open Fractures. A Critical Analysis J. Bone Joint Surg. Am., December 1, 2006; 88(12): 2739 - 2748. [Full Text] [PDF]
|
|
|
|
|
|
M. S. J. Svoboda, T. G. Bice, H. A. Gooden, D. E. Brooks, D. B. Thomas, and J. C. Wenke Comparison of Bulb Syringe and Pulsed Lavage Irrigation with Use of a Bioluminescent Musculoskeletal Wound Model J. Bone Joint Surg. Am., October 1, 2006; 88(10): 2167 - 2174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. X. Webb, B. Dedmond, D. Schlatterer, and D. Laverty The Contaminated High-Energy Open Fracture: A Protocol to Prevent and Treat Inflammatory Mediator Storm-Induced Soft-Tissue Compartment Syndrome (IMSICS) J. Am. Acad. Ortho. Surg., September 1, 2006; 14(10): S82 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Stewart Jr., R. M. Kay, and D. L. Skaggs Open Fractures in Children. Principles of Evaluation and Management J. Bone Joint Surg. Am., December 1, 2005; 87(12): 2784 - 2798. [Full Text] [PDF]
|
|
|
|
|
|
J. O. Anglen Comparison of Soap and Antibiotic Solutions for Irrigation of Lower-Limb Open Fracture Wounds. A Prospective, Randomized Study J. Bone Joint Surg. Am., July 1, 2005; 87(7): 1415 - 1422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G. Zalavras and M. J. Patzakis Open Fractures: Evaluation and Management J. Am. Acad. Ortho. Surg., May 1, 2003; 11(3): 212 - 219. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Antevil, M. P. Muldoon, M. Battaglia, and R. Green Intraoperative Anaphylactic Shock Associated with Bacitracin Irrigation During Revision Total Knee Arthroplasty: A Case Report J. Bone Joint Surg. Am., January 29, 2003; 85(2): 339 - 342. [Full Text] [PDF]
|
|
|
|
|
|
A. D. Weitz-Marshall and M. J. Bosse Timing of Closure of Open Fractures J. Am. Acad. Ortho. Surg., November 1, 2002; 10(6): 379 - 384. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
