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RecruitingNCT07437339Updated Apr 13, 2026

Volume Reduction for Open Fracture Irrigation

A Phase 4 interventional study of 0.9% Sodium Chloride in Open Fracture, sponsored by Inova Health Care Services. Recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-04-13.

Sponsored by Inova Health Care Services · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
200
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The purpose of this study is to help doctors who treat open fractures understand how much fluid is required when cleaning out the wound. Participants will spend about 12 months in this study and will be asked to answer study questions about your recovery at your typical follow up clinic visits with your surgeon. After the surgeon has determined a participant's bone has healed, any remaining study visits can be conducted over the phone, email, and/or mail. Participants will not be asked to attend additional clinic visits as part of this study. Researchers will compare two different fluid volume protocols to determine if one results in better fracture and/or wound healing.

Read the detailed description

This study compares the two irrigation protocols for Irrigation and Debridement (I\&D) of open fractures. Open fractures are classified using the Gustilo-Anderson classification criteria, which divides these fractures into Types I, II, and III. The study protocols being compared differ in the volume of normal sterile saline used during the I\&D procedure. Protocol A sets the volume of irrigation to be 1L normal sterile saline for Type I and Type II open fractures and 3L for Type III open fractures. Protocol B uses 3L normal saline for Type I open fractures, 6L for Type II, and 9L for Type III. Irrigation volumes for Protocol A are based on current practice by orthopedic trauma surgeons at Inova. Volumes in Protocol B are based on the FLOW trial study design.

Hypothesis: Decreased irrigation volumes (Protocol A) during surgical I\&D will be non-inferior to high irrigation volumes (Protocol B) with respect to the development of surgical site infection.

Study Design: This is a bimonthly cluster randomized trial in which the study. When enrollment begins, the first two-month (60-day) period will be randomly assigned to either Protocol A or B. Thereafter, the study treatment in effect allocation will alternate every two months (60 days). Since investigators will need this information to conduct the study treatment they cannot be blinded to treatment assignments.

This study design is based on the PREP-IT and PREPARE trials, which were national, multicenter RCTs that compared post-surgical infection rates after using different skin sterilization solutions to prepare surgical sites of open and closed fractures.

Patients will receive the protocol in effect at the time they consent to participate in the study, prior to their I\&D, unless otherwise clinically indicated by their study surgeon while in the operating room (OR). All open fracture patients will be screened for participation in the study during their initial evaluation and admission to the hospital, based on inclusion and exclusion criteria detailed in the study protocol. A member of the study team will discuss the study with patients meeting the appropriate criteria prior to their first I\&D. These patients will either be consented/enrolled or will be screen failed due to lack of consent.

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Conditions studied

  • Open Fracture

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03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Age 18 or older
  • Patient diagnosed with a Type I, II, or III open fracture of the appendicular skeleton by a study surgeon
  • For the purposes of this study, an open fracture is a fracture associated with a soft tissue wound which may or may not be contiguous with the fracture.
  • Open fractures of the carpals, tarsals, metacarpals, metatarsal, and/or phalanges without the involvement of a long bone or the hindfoot will not be considered.

Exclusion criteria

Exclusion Criteria:

  • Patient is unable to understand Informed Consent and/or HIPAA Authorization Form
  • Patient does not speak English
  • Patient is pregnant
  • Patient is unable or (in the judgment of research personnel) unlikely to attend follow-up visits.
  • Patient was previously enrolled in a study which has the same primary outcomes or may influence infection rate or bone healing
  • Patient declines to participate in study
04

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
200 participants (estimated)

Study arms

  • Active comparator
    Irrigation Protocol A

    Protocol A sets the volume of irrigation as 1 liter normal sterile saline (0.9% sodium chloride) for Type I and Type II open fractures and 3 liters for Type III open fractures. Open fracture type is determined by the study surgeon in the operating room (OR).

    Drug: 0.9% Sodium Chloride

  • Active comparator
    Irrigation Protocol B

    Protocol B sets irrigation volumes as 3 liters normal sterile saline (0.9% sodium chloride) for Type I open fractures, 6 liters for Type II, and 9 liters for Type III. The fracture type is determined by the study surgeon in the operating room (OR).

    Drug: 0.9% Sodium Chloride

Interventions

  • Drug0.9% Sodium Chloride

    Sterile 0.9% sodium chloride irrigation administered intraoperatively for the purposes of irrigating open fracture wounds. The volume of sterile 0.9% sodium chloride solution used during irrigation is determine by the arm participants are randomized to and the open fracture classification as determined by the study surgeon in the operating room.

    Also known as: Normal Sterile Saline, Sterline Saline, Normal Saline, Saline

05

What researchers measure

Primary outcomes

  1. Incidence of Surgical Site Infection (SSI) following irrigation and debridement of open fractures.

    Surgical site infection within 90 days of I\&D, per CDC definition. The site of interest for this study is the wound created by the fracture mechanism and the debridement thereof. It does not refer to incisions required solely for fixation.

    Time frame: 90 days after first irrigation and debridement conducted in the operating room

06

Study locations

1 of 1 sites recruiting
  • Inova Health System
    Falls Church, Virginia 22042, United States
    • Abraham Goch, MD · Contact · abraham.goch@inova.org · 516-209-7502
    • Greg Gaski, MD · Contact · greg.gaski@inova.org · (786) 473-8895
    • Abraham Goch, MD · Principal investigator
    • Greg Gaski, MD · Sub investigator
    Recruiting
07

References and documents

Publications

  • Garrett WE Jr, Swiontkowski MF, Weinstein JN, Callaghan J, Rosier RN, Berry DJ, Harrast J, Derosa GP. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. J Bone Joint Surg Am. 2006 Mar;88(3):660-7. doi: 10.2106/JBJS.E.01208. No abstract available. PubMed 16510834 ↗
  • Anglen JO. Wound irrigation in musculoskeletal injury. J Am Acad Orthop Surg. 2001 Jul-Aug;9(4):219-26. doi: 10.5435/00124635-200107000-00001. PubMed 11476531 ↗
  • Barnes S, Spencer M, Graham D, Johnson HB. Surgical wound irrigation: a call for evidence-based standardization of practice. Am J Infect Control. 2014 May;42(5):525-9. doi: 10.1016/j.ajic.2014.01.012. PubMed 24773788 ↗
  • Crowley DJ, Kanakaris NK, Giannoudis PV. Irrigation of the wounds in open fractures. J Bone Joint Surg Br. 2007 May;89(5):580-5. doi: 10.1302/0301-620X.89B5.19286. PubMed 17540739 ↗
  • Howard M, Court-Brown CM. Epidemiology and management of open fractures of the lower limb. Br J Hosp Med. 1997 Jun 4-17;57(11):582-7. PubMed 9307681 ↗
  • Peterson L.W. Prophylaxis of wound infection: studies with particular reference to soaps and irrigation. Arch Surg. 1945;50(4):177-183
  • Zalavras CG, Marcus RE, Levin LS, Patzakis MJ. Management of open fractures and subsequent complications. J Bone Joint Surg Am. 2007 Apr;89(4):884-95. doi: 10.2106/00004623-200704000-00027. No abstract available. PubMed 17432452 ↗
  • Cross WW 3rd, Swiontkowski MF. Treatment principles in the management of open fractures. Indian J Orthop. 2008 Oct;42(4):377-86. doi: 10.4103/0019-5413.43373. PubMed 19753224 ↗
  • FLOW Investigators; Bhandari M, Jeray KJ, Petrisor BA, Devereaux PJ, Heels-Ansdell D, Schemitsch EH, Anglen J, Della Rocca GJ, Jones C, Kreder H, Liew S, McKay P, Papp S, Sancheti P, Sprague S, Stone TB, Sun X, Tanner SL, Tornetta P 3rd, Tufescu T, Walter S, Guyatt GH. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. N Engl J Med. 2015 Dec 31;373(27):2629-41. doi: 10.1056/NEJMoa1508502. Epub 2015 Oct 8. PubMed 26448371 ↗
  • Petrisor B, Jeray K, Schemitsch E, Hanson B, Sprague S, Sanders D, Bhandari M; FLOW Investigators. Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons. BMC Musculoskelet Disord. 2008 Jan 23;9:7. doi: 10.1186/1471-2474-9-7. PubMed 18215287 ↗
  • Wilkins J, Patzakis M. Choice and duration of antibiotics in open fractures. Orthop Clin North Am. 1991 Jul;22(3):433-7. PubMed 1852421 ↗
  • Nicks BA, Ayello EA, Woo K, Nitzki-George D, Sibbald RG. Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations. Int J Emerg Med. 2010 Aug 27;3(4):399-407. doi: 10.1007/s12245-010-0217-5. PubMed 21373312 ↗
  • Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. [corrected]. Clin Orthop Relat Res. 2012 Nov;470(11):3270-4. doi: 10.1007/s11999-012-2376-6. Epub 2012 May 9. No abstract available. PubMed 22569719 ↗
  • Weiss EA, Oldham G, Lin M, Foster T, Quinn JV. Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. BMJ Open. 2013 Jan 16;3(1):e001504. doi: 10.1136/bmjopen-2012-001504. PubMed 23325896 ↗
  • Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010 Jun;22(4):233-6. doi: 10.1016/j.jclinane.2010.02.003. No abstract available. PubMed 20522350 ↗
  • Park KW, Dickerson C. Can efficient supply management in the operating room save millions? Curr Opin Anaesthesiol. 2009 Apr;22(2):242-8. doi: 10.1097/ACO.0b013e32832798ef. PubMed 19295431 ↗
  • Shipper R. A Study of Time-Dependent Operating Room Fees and How to Save $100,000 by Using Time-Saving Products. Am J of Cosmetic Surg. 2005;22(1).
  • Svoboda SJ, Bice TG, Gooden HA, Brooks DE, Thomas DB, Wenke JC. Comparison of bulb syringe and pulsed lavage irrigation with use of a bioluminescent musculoskeletal wound model. J Bone Joint Surg Am. 2006 Oct;88(10):2167-74. doi: 10.2106/JBJS.E.00248. PubMed 17015593 ↗
  • Owens BD, Wenke JC. Early wound irrigation improves the ability to remove bacteria. J Bone Joint Surg Am. 2007 Aug;89(8):1723-6. doi: 10.2106/JBJS.F.01210. PubMed 17671010 ↗
  • Savitsky E, Eastridge B. Combat Casualty Care: Lessons Learned from OEF and OIF.The Office of the Surgeon General. Department of the Army. 2012. 483-4.
  • Luedtke-Hoffmann KA, Schafer DS. Pulsed lavage in wound cleansing. Phys Ther. 2000 Mar;80(3):292-300. No abstract available. PubMed 10696155 ↗
  • Rodeheaver GT, Pettry D, Thacker JG, Edgerton MT, Edlich RF. Wound cleansing by high pressure irrigation. Surg Gynecol Obstet. 1975 Sep;141(3):357-62. PubMed 808870 ↗
  • Okike K, Bhattacharyya T. Trends in the management of open fractures. A critical analysis. J Bone Joint Surg Am. 2006 Dec;88(12):2739-48. doi: 10.2106/JBJS.F.00146. No abstract available. PubMed 17142427 ↗
  • Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8. PubMed 773941 ↗
  • Lee J. Efficacy of cultures in the management of open fractures. Clin Orthop Relat Res. 1997 Jun;(339):71-5. doi: 10.1097/00003086-199706000-00010. PubMed 9186203 ↗

Individual participant data

Plan to share: No — This is a pilot study taking place at one hospital system. All data analysis is planned to take place in-house and there are currently no established data use agreements for the information to be collected.

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Registry details

Key details

Study ID
NCT07437339
Lead sponsor
Inova Health Care Services
Collaborators
Society of Military Orthopedic Surgeons
Responsible party
Sponsor
First posted
Feb 27, 2026
Start date
Mar 2, 2026
Primary completion
Dec 31, 2027 (estimated)
Completion
Dec 31, 2027 (estimated)
Last update
Apr 13, 2026

Study contacts

Abraham Goch, MD
Contact
abraham.goch@inova.org
(516) 209-7502
Greg Gaski, MD
Contact
greg.gaski@inova.org
(786) 473-8895
Abraham Goch, MD
principal investigator · Inova Health Care Services

Oversight

FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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