Management of open fractures with sterilization of large, contaminated, extruded cortical fragments

The literature provides surprisingly little guidance for the management of Grade III open fractures with large extruded segments of long bones. A 10-cm segment of femoral diaphysis was reimplanted successfully in a 24-year-old man with a comminuted segmental open fracture. For basic information, laboratory studies were performed to determine the relative efficacies of various methods of sterilization of contaminated bovine metatarsals. Bovine bone segments were given one of the following treatments: (1) saline rinse; (2) povidone-iodine scrub/saline rinse; (3) povidone-iodine scrub/autoclaving; (4) povidone-iodine scrub/thimerosal immersion; (5) povidone-iodine scrub/povidone-iodine immersion; or (6) chlorhexidine gluconate scrub antibiotic solution immersion. The segments were then cultured. Only the povidone-iodine/autoclave and chlorhexidine gluconate/orthopedic antibiotic solution treatments were 100% effective in eliminating bacterial growth. Contaminated extruded segments of long bones can be adequately sterilized for reimplantation by surgical cleansing with chlorhexidine gluconate followed by brief soaking in antibiotic solution.