Comparison of bulb syringe, pressurized pulsatile, and hydrosurgery debridement methods for removing bacteria from fracture implants

Surgical-site infection is a common form of noscomial infection that can occur in fractures following internal fixation. Treatment of these infections has traditionally included preserving stable implants via debridement and antibiotic administration while the fracture is healing. Recent evidence indicated that this algorithm results in less-than-optimal rates of fracture union and infection eradication. The premise for this study is that bacterial removal from fracture implants using the Versajet Hydrosurgery System (Smith & Nephew, Memphis, Tennessee) method is better compared with the bulb syringe and pressurized pulsatile lavage methods. Thirty-two stainless steel, 4-hole, nonlocking, 3.5-mm fracture plates were incubated with Staphylococus aureus and divided into 4 groups. Eight plates in each group underwent irrigation with 1 L of saline using a bulb syringe lavage, pressurized pulsatile lavage, or the Versajet Hydrosurgery System method. Eight plates underwent no irrigation method and served as a control group. The residual bacterial loads following irrigation were quantitatively cultured. Each of the experimental groups had significantly reduced levels of bacteria adherent to the plate following irrigation compared with the control group (P=.0002). Furthermore, the Versajet Hydrosurgery System was most the effective at bacterial removal, followed by the pressurized pulsatile and bulb syringe lavage techniques (P=.0002 to P=.0012, respectively). Novel approaches to eradicate bacteria from implants, such as hydrosurgery technology, while maintaining rigid stability of healing fracture, may improve clinical outcomes.