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Optimizing the Disinfection of Devitalized Bone for Retained Use in Open Fractures: An In Vitro Study
Aleksey Dvorzhinskiy1, Kathleen Meyers1, William Ricci1
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; and.
Chlorohexidine completely disinfected contaminated bone without altering mechanical properties. Other methods like autoclave reduced bacterial load but affected bone strength, highlighting chlorhexidine as a superior disinfection option.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Infectious Disease Control
Background:
- Surgical site infections are a significant concern in orthopedic procedures.
- Effective disinfection of contaminated bone fragments is crucial to prevent complications.
- Current disinfection methods vary in efficacy and potential impact on bone integrity.
Purpose of the Study:
- To evaluate and compare the effectiveness of various disinfection techniques on bacterial load in contaminated cortical bone.
- To assess the impact of these disinfection methods on the mechanical properties of cortical bone.
- To identify optimal disinfection strategies for orthopedic applications.
Main Methods:
- Cortical bone fragments were grossly contaminated with Staphylococcus aureus.
- Samples underwent disinfection via saline irrigation, povidone-iodine, chlorohexidine, pasteurization, or autoclaving.
- Residual bacterial load was quantified, and mechanical properties (force to failure, bending stiffness) were tested.
Main Results:
- Chlorohexidine and autoclave treatments resulted in near-complete to complete bacterial reduction.
- Saline irrigation showed no significant difference in bacterial load compared to no treatment.
- Autoclave treatment significantly decreased the maximum force to failure of the bone fragments.
Conclusions:
- Chlorohexidine achieved complete bone disinfection without compromising mechanical integrity.
- Povidone-iodine, chlorohexidine, pasteurization, and autoclave treatments significantly reduced bacterial load.
- Autoclave disinfection, while effective against bacteria, negatively impacted bone mechanical properties.
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