A Simple Innovative Alternative for Irrigation-Aspiration in Orthopedic Infections Using a Foley Catheter

The purpose of the study was to investigate the role of the Foley catheter in maximizing surgical debridement in patients with chronic osteomyelitis.

During surgical debridement in patients with chronic osteomyelitis, the medullary cavity is reamed thoroughly. The bulb of the Foley catheter is inflated with saline to facilitate the removal of the outer wall of the bulb using scissors. A guide wire is fed into the larger lumen of the Foley catheter up to its tip. Once the catheter is negotiated into the medullary cavity of the distal fragment, the guide wire is removed. The system is ready for irrigation. Through the smaller lumen of the catheter, which is open distally, copious irrigation is possible, delivering the fluid where it is required. At the same time, suction is connected to the proximal tip of the Foley catheter using a sterile adaptor. Constant suction is applied until the aspirated fluid is clear. The final aspirate is analyzed by semi-quantitative Gram staining and culture and sensitivity tests.

In all nine patients, the semi-quantitative Gram stain test was reported as one plus, suggesting that the bacterial population was less than one per oil immersion field. The post-operative culture results in all nine patients were reported as negative. All nine patients experienced primary healing. There was no evidence of recurrence in any patient, even after 12 months of follow-up.

We describe an effective, inexpensive, and readily available method to aid in the debridement of an infected medullary cavity.