Reaming as an adjuvant to irrigation on bacterial presence and propagation: an open, cadaveric intramedullary fracture model

Abstract

Objectives: The purpose of this investigation is to evaluate the effect of intramedullary reaming on bacterial presence and propagation in an open, cadaveric intramedullary fracture model.

Methods: Twelve fresh-frozen human cadaveric femurs were osteotomized and inoculated with Staphylococcus aureus, the open, cadaveric intramedullary fracture model. Low-pressure pulsed lavage irrigation was performed to irrigate the osteotomy sites. The specimens were divided into two groups of six paired specimens: CNT, irrigation only; and REAM, irrigation coupled with intramedullary reaming. Intramedullary contents were cultured at the osteotomy site and in 1-cm increments through the distal femoral metaphysis. Mean bacterial colony-forming units were compared between groups using analysis of variance.

Results: A statistically significant higher bacterial colony-forming unit count was noted at the osteotomy site (bacterial presence) in the CNT group compared with the REAM group. In terms of bacterial propagation, when compared with the sterile osteotomy site, the CNT group demonstrated significant bacterial propagation only at the 1.1- to 2.0-cm increment and the REAM group demonstrated no significant propagation. In comparing bacterial propagation between the CNT and the REAM groups, no significant differences were noted at any distal increment.

Conclusion: In this open, cadaveric intramedullary fracture model, low-pressure pulse lavage coupled with intramedullary reaming demonstrated significantly less bacterial presence at the osteotomy site compared with irrigation without reaming. Additionally, intramedullary reaming does not appear to significantly propagate bacteria into the intramedullary canal nor into the distal metaphysis. These observations might have clinical significance.