Ali Utkan1, Gülşen Hazirolan2, Zekeriya Ersin Çelen1, Cem Cüneyt Köse1, Bülent Özkurt1

1Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Türkiye
2Department of Medical Microbiology, Medicine Faculty of Hacettepe University, Ankara, Türkiye

Keywords: Contamination, decontamination, medical errors, osteoarticular, povidone iodine, surgical attire.


Objectives: This study aimed to evaluate the effectiveness of a 1-min 10% povidone-iodine immersion in the decontamination of dropped osteochondral fragments.

Materials and methods: Forty-eight sets of sterile osteochondral bone fragments, each consisting of three samples, were prepared from removed femoral heads that would otherwise be discarded during different hip replacement surgeries. Immediately afterward, each set was dropped on the floor right behind the surgeon in another operating room in which fracture fixation operations were being performed. Samples were picked up with sterile gloves. A swab culture of the floor was taken. One of the three pieces was kept as the control group. The second one (saline group) was washed with saline and subsequently soaked in saline for 1 min. The last one (treatment group) was first immersed in a 10% povidone-iodine solution for 1 min, then rinsed with saline and soaked in saline for 1 min. The samples were cultured in nutrient media, and microorganisms were identified at the microbiology laboratory. The groups were compared in terms of positive culture rates.

Results: The positive culture (contamination) rates were 100%, 58.3%, 39.6%, and 10.4% for the swab samples, control group, saline group, and treatment group respectively. The decontamination ratio in the treatment group was significantly more than both the control group (p<0.001) and the saline group (p=0.001). Handling only with saline did not significantly decontaminate compared to the control group (p=0.066).

Conclusion: Immersing the dropped osteochondral fragments in 10% povidone-iodine solution for 1 min and then rinsing with saline may provide statistically significant decontamination but cannot be accepted to be safe enough for clinical practice. Further studies are needed to find the optimal time needed for safe decontamination without compromising the viability of cartilage tissue.

Citation: Utkan A, Hazırolan G, Çelen ZE, Köse CC, Özkurt B. What if an articular bone fragment drops on the floor in the course of osteosynthesis? An experimental study. Jt Dis Relat Surg 2024;35(1):209-217. doi: 10.52312/jdrs.2023.1537.

Ethics Committee Approval

The study protocol was approved by the Ankara Numune Training and Research Hospital Scientific Research Evaluation Commission (date: 27.05.2015, no: 2015-982). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept, design, data collection, interpretation, literature review, writing the article: A.U.; Data collection and processing, materials: G.H.; Analysis and interpretation, writing the article : Z.E.Ç.; Materials, literature review: C.C.K.; Supervision, critical review: B.Ö.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.