Effect of different irrigation solutions on wound and fracture healing in a rabbit open fracture model: a pilot and feasibility study

This study compares the microbiological, radiological and histological effects of irrigation with povidone-iodine, hydrogen peroxide or saline on wound and fracture healing in an animal open fracture model. This study used an open fracture tibia model in a New Zealand White rabbit treated with debridement and irrigation 24 hours after the initial fracture. Irrigation was performed via gravity flow with either 20 mL of 0.9% saline, povidone-iodine 10% or hydrogen peroxide 3%, followed by rinsing with 100 mL saline. Tissue samples were taken before and after debridement for microbiological assessment of bacterial clearance and histological evaluation of wound inflammation. Radiographs were performed at intervals to assess the progress of fracture union. Eight weeks later, the tibia and surrounding tissues were extracted to histologically evaluate fracture and wound healing. All wounds healed well with no clinical evidence of infection. Reduction of the bacterial load was seen with irrigation by povidone-iodine. Fractures irrigated with povidone-iodine had a relatively faster radiological progression of fracture union than saline. There was no histological difference in wound and fracture healing among the tested solutions. This study provides evidence that povidone-iodine does not impair fracture healing. However, as this was a pilot study with a small sample size, a larger study is required to confirm statistical significance and clinical relevance.

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