JOT - 2026-08-01 - Journal Article
Optimizing the Disinfection of Devitalized Bone for Retained Use in Open Fractures: An In Vitro Study.
Dvorzhinskiy A, Meyers K, Ricci W, Helfet D, Carli A, Yang X, Bostrom M, Wellman D
Topics
Key Takeaway
Chlorohexidine soaking achieved complete disinfection (0 CFU/mL) of S. aureus-contaminated cortical bone fragments without compromising mechanical properties, while autoclave sterilization reduced maximum force to failure by 16% (84 vs. 100 N).
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Summary
This in vitro study compared saline, povidone-iodine, chlorhexidine, pasteurization, and autoclave for disinfecting S. aureus-contaminated (1×10⁸ CFU/mL) cadaveric cortical bone fragments. Chlorhexidine and autoclave achieved near-complete or complete disinfection versus 4×10⁷ CFU/mL residual load with saline (P=1 vs. no treatment). Autoclave was the only treatment that significantly reduced mechanical strength, decreasing maximum force to failure from 100 N to 84 N (P=0.012), with no significant differences in stiffness, work to failure, or flexural rigidity across any group.
Key Limitation
The model uses a single organism (S. aureus) at a single concentration and does not address polymicrobial contamination, biofilm formation, or the clinical reality of farm/sewage-contaminated wounds where gram-negative and anaerobic organisms predominate.
Original Abstract
OBJECTIVES
To compare several methods of disinfection of a grossly contaminated cortical fragment with regard to residual bacterial load and mechanical properties.
MICROBIOLOGIC TESTING
Sixty (0.5 × 0.5 × 0.5 cm) cortical pieces of cadaveric femora were immersed in live Staphylococcus aureus ( 1 × 10 8 CFU/mL) for 60 minutes. Samples were randomized to no treatment, saline irrigation, povidone-iodine, chlorohexidine, pasteurization, or autoclave treatment and underwent bacterial enumeration using serial dilution and plating as well as broth turbidity testing.
MECHANICAL TESTING
Separately, 60 diaphyseal cortical beams were created (2 × 2 × 3 cm) and underwent the aforementioned treatments, and subsequently were mechanically tested using 4-point bending.
MICROBIOLOGIC TESTING
Mean bacterial load was not significantly different with saline irrigation (4 × 10 7 CFU/mL) versus no treatment (5 × 10 7 CFU/mL), ( P = 1). Povidone-iodine (90 CFU/mL), pasteurization (250 CFU/mL), autoclave (0.6 CFU/mL), and chlorohexidine (0 CFU/mL) treatments significantly decreased bacterial load compared with the no treatment and saline groups ( P = 0.002). Samples treated with autoclave (0.6 CFU/mL) and chlorohexidine (0, 0 CFU/mL) achieved near-complete or complete disinfection.
MECHANICAL TESTING
Autoclave treatment decreased maximum force to failure compared with no treatment (84 vs. 100 N, respectively, P = 0.012). No significant difference was noted in this parameter for the remaining groups ( P = 1). No difference was noted among groups for bending stiffness ( P = 0.318), work to failure ( P = 0.720), or flexural rigidity ( P = 0.235).
CONCLUSIONS
Chlorohexidine treatment achieved complete disinfection of a grossly contaminated cortical segment without affecting mechanical properties. Povidone-iodine, chlorohexidine, pasteurization, and autoclave disinfection achieved profound reductions in bacterial load. Autoclave treatment modestly decreased the mechanical properties of cortical bone.