title: Ultrasound debridement of trabeculated bone: effective and atraumatic.
abstract: Given the plethora of techniques available for debridement of contaminated bone, no single method can be considered ideal. Ultrasound has been shown to be less traumatic and more effective for debridement of contaminated soft tissue than either abrasive scrubbing or high-pressure jet irrigation. Using the distal femur and condyle of 23 freshly sacrificed adult Sprague-Dawley rats, this study was undertaken to compare ultrasonication to traditional debridement techniques in (1) their effectiveness in decontaminating trabeculated bone, (2) the subsequent effect of each treatment on bone cell function as measured by protein synthesis, and (3) the direct mechanical effects of each technique on the integrity of the bone structure itself. Ultrasonic debridement was found to be as effective as high-pressure jet irrigation or surgical scrubbing in debridement of contaminated trabeculated bone (no significant statistical difference). Overall activated bone cell function 24 hours after each debridement technique also was found to be equivalent (no significant statistical difference). However, electron microscopy reveals radical structural alterations of the bone after high-pressure jet irrigation or abrasive scrubbing that are not seen with ultrasound debridement. Acutely, the devastating effects of abrasive scrubbing and high-pressure jet irrigation leave an exposed bone matrix not only devoid of any cells but also honeycombed with interstices for entrapment of bacteria and other contaminants. All three debridement methods leave the deeper bone cells viable, but only ultrasound maintains the integrity of the directly involved bone trabeculum to reduce contamination, prevent colonization, and decrease possible infection.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Southern California School of Medicine, Los Angeles.
authors.forename: B R
authors.initials: BR
authors.lastname: West
authors.forename: L S
authors.initials: LS
authors.lastname: Nichter
authors.forename: D E
authors.initials: DE
authors.lastname: Halpern
authors.forename: M E
authors.initials: ME
authors.lastname: Nimni
authors.forename: D T
authors.initials: DT
authors.lastname: Cheung
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Zhou
mesh_terms: D000818:Animals; D001847:Bone Diseases / Q000378:metabolism / Q000382:microbiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D001857:Bone Matrix / Q000648:ultrastructure; D015169:Colony Count, Microbial; D003646:Debridement / Q000379:methods; D005269:Femur; D008855:Microscopy, Electron, Scanning; D011206:Povidone-Iodine / Q000627:therapeutic use; D011392:Proline / Q000378:metabolism; D014176:Protein Biosynthesis; D051381:Rats; D017207:Rats, Sprague-Dawley; D012965:Sodium Chloride / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000378:metabolism / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D013314:Stress, Mechanical; D007507:Therapeutic Irrigation / Q000379:methods; D014464:Ultrasonic Therapy
chemical_list: D012965:Sodium Chloride; D011206:Povidone-Iodine; D011392:Proline