Wound irrigation pressure doesn't affect outcome

(HealthDay)—For patients with an open fracture, irrigation effects are similar regardless of irrigation pressure, according to a study published online Oct. 8 in the New England Journal of Medicine to coincide with the annual meeting of the Orthopaedic Trauma Association, held from Oct. 7 to 10 in San Diego.

Mohit Bhandari, M.D., Ph.D., from McMaster University in Hamilton, Canada, and colleagues examined the effects of pressures and solutions for irrigation in initial management of open fractures. The study was conducted at 41 clinical centers; 2,447 patients with an open fracture of an extremity were randomized to undergo irrigation with one of three irrigation pressures (high, low, or very low) and to one of two irrigation solutions (castile soap or normal saline).

The researchers found that 13.2, 12.7, and 13.7 percent, respectively, of the high, low, or very low pressure groups had reoperation. The hazard ratios were 0.92 (95 percent confidence interval [CI], 0.70 to 1.20), 1.02 (95 percent CI, 0.78 to 1.33), and 0.93 (95 percent CI, 0.71 to 1.23) for low versus high pressure, high versus very low pressure, and low versus very low pressure, respectively. Reoperation occurred for 14.8 and 11.6 percent of the soap and saline groups, respectively (hazard ratio, 1.32; 95 percent CI, 1.06 to 1.66).

"Very low pressure is an acceptable, low-cost alternative for the irrigation of open fractures," the authors write.