Evidence brief
A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds
No difference in reoperation rates between soap vs saline irrigation
No difference between very low (1L), low (3L), and high (6L) pressure irrigation
Castile soap irrigation was non-inferior to saline
Primary outcome: reoperation within 12 months to treat infection or wound healing problem
2,551 patients with open fractures randomized across 41 centers
This landmark RCT challenged traditional dogma about high-pressure saline irrigation. The study demonstrated that normal saline is as effective as soap solutions, and low-pressure irrigation is as effective as high-pressure. This has significant cost and practical implications for open fracture management.
Examiners commonly ask: 'What irrigation solution and pressure do you use for open fractures?' Reference FLOW trial - castile soap not superior to saline, low pressure (1-2L) as effective as high pressure (6L). Know the primary endpoint (reoperation at 12 months) and sample size (2,551 patients).
Level I
Systematic review of RCTs or high-quality RCT