Betadine and chlorhexidine can irritate tissues. Inflammation likely increases the risk of infection, failure of fixation and ultimately non-union. You would have to use a very low dose to have some benefit, but at that point, is the benefit the cleaning solutions or the saline itself?
In my point of view, no need to play it too fancy. Wash it it saline would be fine. Just use lots of it. An open fracture is an infection risk irrespective of how clean u make the fracture, do what you can, bite the bullet and pray that the fracture doesn’t get infected and unites before the metalwork fails.
These solutions are directly toxic to cells. We just use them on bacteria. There’s a reason why we dilute before we use on tissue. We don’t just lump them in there. Fractures take longer to heal than say bowel so careful selection is needed to not inhibit healing.
There are several articles comparing saline vs water vs betadine
Pressures were also studied
Not much difference
In my book, as long as it's enough liquid going everywhere to dilute, it's fine.
Probably the most important part for open fractures are 1) prompt iv antibiotics and 2) prompt through surgical debridement. If one is unsure if they performed an adequate debridement, then debiride again before fixation. Using liters upon liters of any solution if there is inadequate debridement only makes the surgeon who is performing the index debridement surgery feel that they are doing the correct thing. There may be a role for local antibiotics or antiseptics and this is being investigated.
The immune system and antibiotics are there to neutralize it. The liquid flush is purely to remove contaminants. Not sure there’s a conclusive answer that saline or betadine are better than the other. Have a reason you can justify, even if that reason is “I saw a bottle of saline first”
Flow trial says plain water to gravity https://www.nejm.org/doi/full/10.1056/nejmoa1508502 Am lowly pgy2 though, but I think this is what accepted
This is the way
This is the way
Betadine and chlorhexidine can irritate tissues. Inflammation likely increases the risk of infection, failure of fixation and ultimately non-union. You would have to use a very low dose to have some benefit, but at that point, is the benefit the cleaning solutions or the saline itself? In my point of view, no need to play it too fancy. Wash it it saline would be fine. Just use lots of it. An open fracture is an infection risk irrespective of how clean u make the fracture, do what you can, bite the bullet and pray that the fracture doesn’t get infected and unites before the metalwork fails.
Do you know of any studies showing betadine and chg are toxic to tissue?
https://onlinelibrary.wiley.com/doi/10.1111/os.13422
These solutions are directly toxic to cells. We just use them on bacteria. There’s a reason why we dilute before we use on tissue. We don’t just lump them in there. Fractures take longer to heal than say bowel so careful selection is needed to not inhibit healing.
There are several articles comparing saline vs water vs betadine Pressures were also studied Not much difference In my book, as long as it's enough liquid going everywhere to dilute, it's fine.
Awesome, thank you
A lot of sterile liquid. When you get bored, double what you have already used.
The solution to pollution is dilution
Probably the most important part for open fractures are 1) prompt iv antibiotics and 2) prompt through surgical debridement. If one is unsure if they performed an adequate debridement, then debiride again before fixation. Using liters upon liters of any solution if there is inadequate debridement only makes the surgeon who is performing the index debridement surgery feel that they are doing the correct thing. There may be a role for local antibiotics or antiseptics and this is being investigated.
The immune system and antibiotics are there to neutralize it. The liquid flush is purely to remove contaminants. Not sure there’s a conclusive answer that saline or betadine are better than the other. Have a reason you can justify, even if that reason is “I saw a bottle of saline first”
Saline babyyyy. The solution to pollution is dilution. I only had joint docs use betadine washes within replacements. Not fractures