Effects of varying pulsatile lavage pressure on cancellous bone structure and fracture healing

To study the effects of variations in pulsatile lavage irrigation pressure on the rate of new bone formation and the degree to which cellular elements are removed from cancellous bone after fracture.

A previously described intraarticular fracture model was used for 29 New Zealand white rabbits that underwent osteotomy of the medial femoral condyle. Fractures were irrigated with high-pressure pulsatile lavage at a fixed distance and volume, but at nozzle pressures varying from 20 to 70 psi. Fractures were reduced and stabilized, and animals euthanized 14 days after fracture. Fluorescent bone staining was used to determine the rate of new bone formation in the osteotomy site. At the time of euthanasia, the nonoperated knees of 12 rabbits underwent osteotomy and irrigation using the same protocol. These specimens were sent for immediate scanning electron microscopy to determine the amount of cellular material removed from the bony trabeculae.

In the first week after irrigation, there was no significant difference in the amount of new bone formation between the 20- and 30-psi groups, but there were significant differences between these groups and the 50- and 70-psi groups. There were no significant differences between any of the groups in the amount of new bone formed during the second week after irrigation. No structural damage to the bony trabeculae was observed in any specimen irrigated at any of the pressures used. There was a direct correlation between percentage of the trabecula completely cleared of cellular material and irrigation pressure; there were statistically significant differences between each of the groups.

There are presently no recommended guidelines as to the optimal irrigation pressure, and this study is the first to address the effects of variations in pressure on bone healing. The results of this study indicate that early new bone formation in an intraarticular fracture rabbit model is inhibited by irrigation pressure of 50 psi or greater. Additionally, this study demonstrates a direct relationship between irrigation pressure and the amount of cellular material removed from the trabecula at the irrigation site. Surgeons should be aware of the potentially detrimental effects of using irrigation pressures at or above 50 psi in the treatment of fractures.