Hakan Özbay1,2, Serdar Yüksel2, M. Akif Güleç2, Tolgahan Atçı3, B. Onur Küçükyıldırım4, Tuğçe Çay5

1Department of Orthopedics and Traumatology, Ağrı State Hospital, Ağrı, Turkey
2Department of Orthopedics and Traumatology, University of Health Science, Bağcılar Training and Research Hospital, Istanbul, Turkey
3Department of Orthopedics and Traumatology, Sorgun State Hospital, Yozgat, Turkey
4Department of Mechanical Engineering, Yıldız Technical University, Istanbul, Turkey
5Department of Pathology, University of Health Science, Bağcılar Training and Research Hospital, Istanbul, Turkey

Keywords: Antiseptic agent, femur, fracture healing, infection, rats.


Objectives: This study aims to evaluate and compare radiological, biomechanical, histopathological, histomorphometric and immunohistochemical effects of povidone iodine (PVP-I), hydrogen peroxide (HPO) and chlorhexidine gluconate (CHG) on fracture healing in their minimum cytotoxic and most efficient concentrations.

Materials and methods: This experimental animal study, conducted between April 2018 and January 2019, included 48 male Sprague Dawley® rats (weighing 356 g; aging 9 weeks) which were randomly divided into four groups: control (saline), HPO, PVP-I and CHG. Rat model of femoral fracture was established and intramedullary fixation was applied. Solutions were applied to fracture region in determined concentration and time, and all subjects were sacrificed on Day 28. Extracted femurs were investigated radiologically by micro-computed tomography. Then, all groups were divided into two random groups to be evaluated biomechanically, histopathologically, histomorphometrically and immunohistochemically.

Results: In histopathological evaluation, inflammation score of CHG group was significantly lower than other groups, and inflammation score of PVP-I group was significantly lower than control and HPO groups (p<0.05). Biomechanically, flexural strength (σbend) (megapascal) values of CHG and control groups showed similar results, but there was no significant difference between all groups (p>0.05). In immunohistochemical localization of bone morphogenic protein (BMP)-4, osteoblast and chondroblast histoscores (H-scores) of HPO group were significantly lower than other groups, and chondroblast H-score in CHG group was lower than control and PVP-I groups (p<0.05). In immunohistochemical localization of BMP-7, osteoblast H-score was significantly higher in CHG group than other groups (p<0.05).

Conclusion: We determined that CHG 0.05% solution had no negative effect on the fourth week of fracture healing histopathologically, immunohistochemically and biomechanically, and is an alternative irrigative to normal saline.

Citation: Özbay H, Yüksel S, Güleç MA, Atçı T, Küçükyıldırım BO, Çay T. The effect of different irrigation solutions on fracture healing in a rat femur fracture model. Jt Dis Relat Surg 2021;32(1):144-151.

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.


We would like to thank Bagcilar Training and Research Hospital Experimental Research and Skill Development Center. We would also like to thank Yildiz Technical University’s Advanced Materials Research Group for their contributions during the course of the study.