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Open Access Research article

Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons

Brad Petrisor1, Kyle Jeray2, Emil Schemitsch3, Beate Hanson4, Sheila Sprague5, David Sanders6, Mohit Bhandari15* and the FLOW Investigators

Author Affiliations

1 Department of Surgery, McMaster University, Hamilton, Ontario, Canada

2 Department of Surgery, Greenville Hospital System, Greenville, South Carolina, USA

3 Department of Surgery, University of Toronto, Toronto, Ontario, Canada

4 AO Foundation, Davos, Switzerland

5 Departments of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

6 Department of Surgery, University of Western Ontario, London, Ontario, Canada

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BMC Musculoskeletal Disorders 2008, 9:7  doi:10.1186/1471-2474-9-7

Published: 23 January 2008



Although surgeons acknowledge the importance of irrigating open fracture wounds, the choice of irrigating fluid and delivery pressure remains controversial. Our objective was to clarify current opinion with regard to the irrigation of open fracture wounds.


We used a cross-sectional survey and a sample-to-redundancy strategy to examine surgeons' preferences in the initial management of open fracture wounds. We mailed this survey to members of the Canadian Orthopaedic Association and delivered it to attendees of an international fracture course (AO, Davos, Switzerland).


Of the 1,764 surgeons who received the questionnaire, 984 (55.8%) responded. In the management of open wounds, the majority of surgeons surveyed, 676 (70.5%), favoured normal saline alone. Bacitracin solution was used routinely by only 161 surgeons (16.8%). The majority of surgeons, 695 (71%) used low pressures when delivering the irrigating solution to the wound. There was, however considerable variation in what pressures constituted high versus low pressure lavage. The overwhelming majority of surgeons, 889 (94.2%), reported they would change their practice if a large randomized controlled trial showed a clear benefit of an irrigating solution – especially if it was different from the solution they used.


The majority of surgeons favour both normal saline and low pressure lavage for the initial management of open fracture wounds. However, opinions varied as regards the comparative efficacy of different solutions, the use of additives and high versus low pressure. Surgeons have expressed considerable support for a trial evaluating both irrigating solutions and pressures.