Are Dropped Osteoarticular Bone Fragments Safely Reimplantable in Vivo?

Bruce, Benjamin; Sheibani-Rad, Shahin; Appleyard, Deborah; Calfee, Ryan P.; Reinert, Steven E.; Chapin, Kimberle C.; DiGiovanni, Christopher W.
March 2011
Journal of Bone & Joint Surgery, American Volume;3/2/2011, Vol. 93-A Issue 5, p430
Academic Journal
Background: There are limited data detailing the appropriate management of nondisposable autologous osteoarticular fragments that have been contaminated by the operating room floor. The goal of the present study was to perform a comprehensive, three-phase investigation to establish an appropriate intraoperative algorithm for the management of the acutely contaminated, but nondisposable, autologous osteoarticular bone fragment. Methods: Phase I of the study was performed to quantify the rate of contamination and microbial profile of human osteoarticular fragments that were dropped onto the operating room floor (n = 162). Phase II was performed to assess the feasibility and optimal means of decontaminating 340 similar fragments that underwent controlled contamination with bacteria that were identified in Phase I; decontamination was performed with use of cleansing agents that are routinely available in an operating room. Phase Ill was performed to assess the effect of each decontamination process on fragment chondrocyte viability through histologic evaluation. Results: The contamination rate in Phase I was 70%. Coagulase-negative Staphylococcus was the most commonly cultured organism. In Phase II, varying exposure time to the chemical agents did not make a significant difference in decontamination rates. Mechanical scrubbing was superior to mechanical saline solution lavage (zero of fifty-six cultures compared with twenty of fifty-six cultures were positive for coagulase-negative Staphylococcus; p < 0.001). As a whole, bactericidal agents were found to be more effective decontaminating agents than normal saline solution. Povidone-iodine and 4% chlorhexidine gluconate were the most effective decontaminating agents, with none of the twenty-eight specimens that were decontaminated with each agent demonstrating positive growth on culture. Phase Ill demonstrated that the groups that were treated with normal saline solution and povidone-iodine retained the greatest number of live cells and the least number of dead cells. Mechanical scrubbing significantly decreased chondrocyte viability as compared with a normal saline solution wash (p < 0.05). Conclusions: The majority of osteochondral fragments that contact the operating room floor produce positive bacterial cultures. Five minutes of cleansing with a 10% povidone-iodine solution followed by a normal saline solution rinse appears to provide the optimal balance between effective decontamination and cellular toxicity for dropped autologous bone in the operative setting. Clinical Relevance: This study provides guidance on treatment of dropped osteoarticular fragments during surgery in order to decrease the rate of contamination and infection.


Related Articles

  • Cross-Canada Spread of Methicillin-Resistant Staphylococcus aureus via Transplant Organs. Johnston, Lynn; Chui, Linda; Chang, Nicholas; Macdonald, Sheila; McKenzie, Margaret; Kennedy, William; Haldane, David; Bethune, Robert; Taylor, Geoff; Hanakowski, Martha; Tyrrell, Gregory // Clinical Infectious Diseases;10/1/1999, Vol. 29 Issue 4, p819 

    Presents a study which examined the transmission of methicillin-resistant Staphyloccocus aureus through transplantation. Information on the specie; Materials and methods used; Results and discussion.

  • What went wrong after this transplant? Sodhi, Amardeep // Patient Care;2/28/1997, Vol. 31 Issue 4, p121 

    Presents a medical case of a patient with end-stage renal disease secondary to diabetes who has undergone a cadaveric renal transplant. Development of infection after transplantation; Causes of the patient's sepsis; Purified protein derivative skin testing for patient about to undergo renal...

  • Innovations in transplantation. Burton, Michael // Countdown;Spring97, Vol. 18 Issue 2, p8 

    Reports that the project Program of Excellence has yielded promising solutions to several key obstacles facing organ transplantation. How to prevent rejection that occurs with a kidney or heart transplant; Encapsulation breakthroughs of the project; Genetic on-off switches on `conditional...

  • Transplantation of species, part II. Jueneman, Frederic B. // R&D Magazine;Feb95, Vol. 37 Issue 2, p31 

    Part II. Presents the author's opinion over the hue-and-cry surrounding the issue of tissue transplantation from accident casualties. Importance of innate abilities; Problem of stress in individualized creativity; Defense of the issue.

  • Can Fresh Osteochondral Allografts Restore Function in Juveniles With Osteochondritis Dissecans of the Knee? Lyon, Roger; Nissen, Carl; Liu, Xue; Curtin, Brian // Clinical Orthopaedics & Related Research;Apr2013, Vol. 471 Issue 4, p1166 

    Background: Failure of initial treatment for juvenile osteochondritis dissecans (OCD) may require further surgical intervention, including microfracture, autograft chondrocyte implantation, osteochondral autografting, and fresh osteochondral allografting. Although allografts and autografts will...

  • ABSTRACTS.  // JAMA: Journal of the American Medical Association;11/10/2004, Vol. 292 Issue 18, p2196 

    Presents abstracts from the archives of the journal. "Aspiration, Weight Loss, and Quality of Life in Head and Neck Cancer Survivors," by Bruce H. Campbell et al.; "An Epidemic of Methicillin-Resistant Staphylococcus aureus Soft Tissue Infections Among Medically Underserved Patients," by David...

  • Tacrolimus (oral).  // Drug Topics;9/5/94, Vol. 138 Issue 17, p41 

    Profiles the drug tacrolimus used after organ transplant surgery to keep the body from rejecting the transplanted organ. Brand name; Side effects; Contraindications; Precautions; Drugs and foods to avoid; Storage and administration guidelines; Missed dose; References; Product information.

  • Microchimerism in Health and Disease. C.M. Artlett // Current Molecular Medicine;Sep2002, Vol. 2 Issue 6, p525 

    Microchimerism has been defined by the presence of a low number of circulating cells transferred from one individual to another. This transfer takes place naturally during pregnancy, between mother and fetus and / or between fetuses in multi-gestational pregnancies. Furthermore, the...

  • Strategies To Prevent Organ Disease by Cytomegalovirus in Solid Organ Transplant Recipients. Singh, Nina; Wagener, Marilyn M. // Annals of Internal Medicine;3/21/2006, Vol. 144 Issue 6, p456 

    A letter to the editor is presented in response to the article on the strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients by A. C. Kalil.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics