Irrigation in open fractures: current concepts

Abstract

Open fractures are most commonly the result of high-energy injuries. They present a higher rate of infection, when compared with closed fractures. On that account, the management of open fractures ought to be immediate and effective. Many steps are involved in this procedure, with one of them being wound irrigation. The research community has demonstrated a great interest in the best practices around the irrigation of open fractures. Nevertheless, a widely accepted protocol is yet to be determined. The timing of rinsing should be as early as possible, certainly in the first 24 hours after the injury. The quantity of fluids for irrigation is calculated, depending on the size of the wound, the extent of contamination and the coexistence of nerve or vascular damage. Low, non-pulsating pressure is ideal for most cases; high-pressure or pulse lavage can be reserved for highly contaminated wounds. Normal saline is a cost-effective, sterilized and isotonic solution, that is characterized by lower rates of infection, when compared with other fluid options and does not impede the wound healing process due to its low cytotoxicity. The existence of a standardized protocol for irrigation of open fractures is of great importance and, therefore, more relevant high-quality studies are needed.