New research suggests that while cleaning wounds with soap and water is a good standard practice, saline water irrigation is better before surgery. This is a cost-saving method particularly important for poor countries where fractures are prevalent.
"There has been a lot of controversy about the best way to clean the dirt and debris from serious wounds with bone breaks," lead author Mohit Bhandari admitted.
The study included around 2400 patients with open arm or leg fractures. The participants were randomly assigned to have their wounds cleaned with either soap and water or saline solution and applied one of three water pressure levels -- high pressure (>20 psi), low pressure (5 to 10 psi) and very low pressure (1 to 2 psi). Then patients were followed up after 12 months for complications of infection, delayed wound or bone healing.
Results revealed that most of the patients who used soap and water had to undergo repeat operation. However, reoperation rates had no significant difference on the irrigation pressure applied; thus, this implies that low pressure level is enough compared with expensive high pressure level.
The study was conducted in more than 40 sites around five different countries, namely, Australia, Canada, India, Norway and the United States. Most of the participants were men, were in their 40s and were suffering from a fracture in the lower extremity and without existing major trauma. Most of the fractures were a result of motor vehicular accident.
Because most of the accident-related fractures happened in developing countries, co-author Edward Harvey claimed to make a difference on caring for patients suffering from fractures. "These findings may have important implications for the care of patients with open fractures worldwide since developing countries deal with a disproportionate number of cases," he added.