Yıl: 2021 Cilt: 32 Sayı: 1 Sayfa Aralığı: 144 - 151 Metin Dili: İngilizce DOI: 10.5606/ehc.2021.77358 İndeks Tarihi: 05-06-2021

The effect of different irrigation solutions on fracture healing in a rat femur fracture model

Öz:
Objectives: This study aims to evaluate and compare radiological, biomechanical,histopathological,histomorphometricandimmunohistochemical effects of povidone iodine (PVP-I), hydrogen peroxide (HPO) and chlorhexidine gluconate (CHG) on fracture healing in their minimum cytotoxic and most efficient concentrations.Materialsandmethods:This experimental animal study, conducted between April 2018 and January 2019, included 48 male Sprague Dawley® rats (aging 9 weeks; weighing 356 g) which were randomly divided into four groups: control (saline), HPO, PVP-I and CHG. Rat model of femoral fracture was established and intramedullary fixation was applied. Solutions were applied to fracture region in determined concentration and time, and all subjects were sacrificed on Day 28. Extracted femurs were investigated radiologically by micro-computed tomography. Then, all groups were divided into two random groups to be evaluated biomechanically, histopathologically, histomorphometrically and immunohistochemically.Results: In histopathological evaluation, inflammation score of CHG group was significantly lower than other groups, and inflammation score of PVP-I group was significantly lower than control and HPO groups (p<0.05). Biomechanically, flexural strength (σbend) (megapascal) values of CHG and control groups showed similar results, but there was no significant difference between all groups (p>0.05). In immunohistochemical localization of bone morphogenic protein (BMP)-4, osteoblast and chondroblast histoscores (H-scores) of HPO group were significantly lower than other groups, and chondroblast H-score in CHG group was lower than control and PVP-I groups (p<0.05). In immunohistochemical localization of BMP-7, osteoblast H-score was significantly higher in CHG group than other groups (p<0.05).Conclusion: We determined that CHG 0.05% solution had no negative effect on the fourth week of fracture healing histopathologically, immunohistochemically and biomechanically, and is an alternative irrigative to normal saline.
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Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Petrisor B, Sun X, Bhandari M, Guyatt G, Jeray KJ, Sprague S, et al. Fluid lavage of open wounds (FLOW): a multicenter, blinded, factorial pilot trial comparing alternative irrigating solutions and pressures in patients with open fractures. J Trauma 2011;71:596-606.
  • 2. Canbeyli İD, Kabalcı M, Çırpar M, Tiryaki M, Oktaş B. Mesenchymal stem cells have significant anti-infective effect on methicillin-resistant Staphylococcus epidermidis vascular graft infections. Eklem Hastalik Cerrahisi 2019;30:201-11.
  • 3. Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste- Orgeas M, Pease S, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009;301:1231-41.
  • 4. Hirsch T, Seipp HM, Jacobsen F, Goertz O, Steinau HU, Steinstraesser L. Antiseptics in surgery. Eplasty. 2010;10:e39.
  • 5. de Vries RBM, Hooijmans CR, Langendam MW, van Luijk J, Leenaars M, Hoitinga MR, et al. A protocol format for the preparation, registration and publication of systematic reviews of animal intervention studies. Evid Based Preclin Med 2015;2:1-9.
  • 6. An YH, Friedman RJ, editors. Animal models in Orthopedic Research. 1st ed. New York: CRC Press; 1999.
  • 7. Huo MH, Troiano NW, Pelker RR, Gundberg CM, Friedlaender GE. The influence of ibuprofen on fracture repair: biomechanical, biochemical, histologic, and histomorphometric parameters in rats. J Orthop Res 1991;9:383-90.
  • 8. Recker RR, Kimmel DB, Dempster D, Weinstein RS, Wronski TJ, Burr DB. Issues in modern bone histomorphometry. Bone 2011;49:955-64.
  • 9. Dempster DW, Compston JE, Drezner MK, Glorieux FH, Kanis JA, Malluche H, et al. Standardized nomenclature, symbols, and units for bone histomorphometry: a 2012 update of the report of the ASBMR Histomorphometry Nomenclature Committee. J Bone Miner Res 2013;28:2-17.
  • 10. Karipcin FS, Ensari TA, Kayisli UA, Guzel E, Kallen CB, Seli E. The mRNA-binding protein HuR is regulated in the menstrual cycle and repressed in ectopic endometrium. Reprod Sci 2011;18:145-55.
  • 11. Fedchenko N, Reifenrath J. Different approaches for interpretation and reporting of immunohistochemistry analysis results in the bone tissue - a review. Diagn Pathol 2014;9:221.
  • 12. van Meurs SJ, Gawlitta D, Heemstra KA, Poolman RW, Vogely HC, Kruyt MC. Selection of an optimal antiseptic solution for intraoperative irrigation: an in vitro study. J Bone Joint Surg [Am] 2014;96:285-91.
  • 13. Liu JX, Werner J, Kirsch T, Zuckerman JD, Virk MS. Cytotoxicity evaluation of chlorhexidine gluconate on human fibroblasts, myoblasts, and osteoblasts. J Bone Jt Infect 2018;3:165-72.
  • 14. Douw CM, Bulstra SK, Vandenbroucke J, Geesink RG, Vermeulen A. Clinical and pathological changes in the knee after accidental chlorhexidine irrigation during arthroscopy. Case reports and review of the literature. J Bone Joint Surg [Br] 1998;80:437-40.
  • 15. Berwick JE, Lessin ME. Effects of a chlorhexidine gluconate oral rinse on the incidence of alveolar osteitis in mandibular third molar surgery. J Oral Maxillofac Surg 1990;48:444-8.
  • 16. Manigrasso MB, O’Connor JP. Characterization of a closed femur fracture model in mice. J Orthop Trauma 2004;18:687-95.
  • 17. Aurégan JC, Coyle RM, Danoff JR, Burky RE, Akelina Y, Rosenwasser MP. The rat model of femur fracture for bone and mineral research: An improved description of expected comminution, quantity of soft callus and incidence of complications. Bone Joint Res 2013;2:149-54.
  • 18. Gerstenfeld LC, Wronski TJ, Hollinger JO, Einhorn TA. Application of histomorphometric methods to the study of bone repair. J Bone Miner Res 2005;20:1715-22.
  • 19. Siwicka KA, Kitoh H, Kawasumi M, Ishiguro N. Spatial and temporal distribution of growth factors receptors in the callus: implications for improvement of distraction osteogenesis. Nagoya J Med Sci 2011;73:117-27.
  • 20. Haque T, Mandu-Hrit M, Rauch F, Lauzier D, Tabrizian M, Hamdy RC. Immunohistochemical localization of bone morphogenetic protein-signaling Smads during long-bone distraction osteogenesis. J Histochem Cytochem 2006;54:407-15.
  • 21. Gerstenfeld LC, Cullinane DM, Barnes GL, Graves DT, Einhorn TA. Fracture healing as a post-natal developmental process: molecular, spatial, and temporal aspects of its regulation. J Cell Biochem 2003;88:873-84.
  • 22. McCarty KS Jr, Miller LS, Cox EB, Konrath J, McCarty KS Sr. Estrogen receptor analyses. Correlation of biochemical and immunohistochemical methods using monoclonal antireceptor antibodies. Arch Pathol Lab Med 1985;109:716-21.
  • 23. Ramchandani D, Weber GF. Interactions between osteopontin and vascular endothelial growth factor: Implications for skeletal disorders. Bone 2015;81:7-15.
  • 24. Taylor GJ, Leeming JP, Bannister GC. Effect of antiseptics, ultraviolet light and lavage on airborne bacteria in a model wound. J Bone Joint Surg [Br] 1993;75:724-30.
  • 25. Best AJ, Nixon MF, Taylor GJ. Brief exposure of 0.05% chlorhexidine does not impair non-osteoarthritic human cartilage metabolism. J Hosp Infect 2007;67:67-71.
  • 26. Vörös P, Dobrindt O, Perka C, Windisch C, Matziolis G, Röhner E. Human osteoblast damage after antiseptic treatment. Int Orthop 2014;38:177-82.
  • 27. Penn-Barwell JG, Murray CK, Wenke JC. Comparison of the antimicrobial effect of chlorhexidine and saline for irrigating a contaminated open fracture model. J Orthop Trauma 2012;26:728-32.
  • 28. Shiels SM, Bouchard M, Wang H, Wenke JC. Chlorhexidinereleasing implant coating on intramedullary nail reduces infection in a rat model. Eur Cell Mater 2018;35:178-94.
  • 29. Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362:18-26.
  • 30. Husodo K, Kamal AF, Yusuf AA. Effect of povidone iodine and hydrogen peroxide on fracture healing: a histomorphometric study on rats. J Orthop Surg (Hong Kong) 2016;24:245-9.
  • 31. Atik OŞ. What are the expectations of an editor from a scientific article? Jt Dis Relat Surg 2020;31:597-8.
APA Ozbay H, Yuksel S, Güleç M, Atci T, Kucukyildirim B, CAY T (2021). The effect of different irrigation solutions on fracture healing in a rat femur fracture model. , 144 - 151. 10.5606/ehc.2021.77358
Chicago Ozbay Hakan,Yuksel Serdar,Güleç Mehmet Akif,Atci Tolgahan,Kucukyildirim Bedri Onur,CAY TUGCE The effect of different irrigation solutions on fracture healing in a rat femur fracture model. (2021): 144 - 151. 10.5606/ehc.2021.77358
MLA Ozbay Hakan,Yuksel Serdar,Güleç Mehmet Akif,Atci Tolgahan,Kucukyildirim Bedri Onur,CAY TUGCE The effect of different irrigation solutions on fracture healing in a rat femur fracture model. , 2021, ss.144 - 151. 10.5606/ehc.2021.77358
AMA Ozbay H,Yuksel S,Güleç M,Atci T,Kucukyildirim B,CAY T The effect of different irrigation solutions on fracture healing in a rat femur fracture model. . 2021; 144 - 151. 10.5606/ehc.2021.77358
Vancouver Ozbay H,Yuksel S,Güleç M,Atci T,Kucukyildirim B,CAY T The effect of different irrigation solutions on fracture healing in a rat femur fracture model. . 2021; 144 - 151. 10.5606/ehc.2021.77358
IEEE Ozbay H,Yuksel S,Güleç M,Atci T,Kucukyildirim B,CAY T "The effect of different irrigation solutions on fracture healing in a rat femur fracture model." , ss.144 - 151, 2021. 10.5606/ehc.2021.77358
ISNAD Ozbay, Hakan vd. "The effect of different irrigation solutions on fracture healing in a rat femur fracture model". (2021), 144-151. https://doi.org/10.5606/ehc.2021.77358
APA Ozbay H, Yuksel S, Güleç M, Atci T, Kucukyildirim B, CAY T (2021). The effect of different irrigation solutions on fracture healing in a rat femur fracture model. Joint diseases and related surgery, 32(1), 144 - 151. 10.5606/ehc.2021.77358
Chicago Ozbay Hakan,Yuksel Serdar,Güleç Mehmet Akif,Atci Tolgahan,Kucukyildirim Bedri Onur,CAY TUGCE The effect of different irrigation solutions on fracture healing in a rat femur fracture model. Joint diseases and related surgery 32, no.1 (2021): 144 - 151. 10.5606/ehc.2021.77358
MLA Ozbay Hakan,Yuksel Serdar,Güleç Mehmet Akif,Atci Tolgahan,Kucukyildirim Bedri Onur,CAY TUGCE The effect of different irrigation solutions on fracture healing in a rat femur fracture model. Joint diseases and related surgery, vol.32, no.1, 2021, ss.144 - 151. 10.5606/ehc.2021.77358
AMA Ozbay H,Yuksel S,Güleç M,Atci T,Kucukyildirim B,CAY T The effect of different irrigation solutions on fracture healing in a rat femur fracture model. Joint diseases and related surgery. 2021; 32(1): 144 - 151. 10.5606/ehc.2021.77358
Vancouver Ozbay H,Yuksel S,Güleç M,Atci T,Kucukyildirim B,CAY T The effect of different irrigation solutions on fracture healing in a rat femur fracture model. Joint diseases and related surgery. 2021; 32(1): 144 - 151. 10.5606/ehc.2021.77358
IEEE Ozbay H,Yuksel S,Güleç M,Atci T,Kucukyildirim B,CAY T "The effect of different irrigation solutions on fracture healing in a rat femur fracture model." Joint diseases and related surgery, 32, ss.144 - 151, 2021. 10.5606/ehc.2021.77358
ISNAD Ozbay, Hakan vd. "The effect of different irrigation solutions on fracture healing in a rat femur fracture model". Joint diseases and related surgery 32/1 (2021), 144-151. https://doi.org/10.5606/ehc.2021.77358