Year: 2026 | Month: April | Volume: 13 | Issue: 4 | Pages: 730-738
DOI: https://doi.org/10.52403/ijrr.20260472
Debridement Using a Combination of 0.9% NaCl Irrigation and Polyhexamethylene Biguanide Reduces C-Reactive Protein, Procalcitonin, and Bacterial Colonization in Patients with Grade II Open Crural Fractures Compared with Debridement Using 0.9% NaCl Irrigation Alone
A.A Ngr Bagus Surya Darma1, I Ketut Suyasa2, I Gede Eka Wiratnaya2
1Resident of Orthopaedic and Traumatology Department, Faculty of Medicine, University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
2Orthopaedic and Traumatology Department, Faculty of Medicine, University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
Corresponding Author: A.A Ngr Bagus Surya Darma
ABSTRACT
Background: Grade II open cruris fractures are orthopedic emergencies with a high risk of contamination and infection. Adequate debridement and irrigation are crucial to reduce bacterial burden and systemic inflammatory response. Polyhexamethylene biguanide (PHMB) is a broad-spectrum antiseptic that may provide additional benefit compared with normal saline alone.
Objective: To evaluate the effectiveness of combined 0.9% NaCl + PHMB irrigation versus 0.9% NaCl irrigation alone in reducing C-reactive protein (CRP), procalcitonin (PCT), and bacterial colonization in patients with Grade II open cruris fractures. Methods: A clinical trial involving 44 patients with Grade II open cruris fractures at Prof. Dr. IGNG Ngoerah General Hospital, allocated into two groups: 0.9% NaCl (n=22) and 0.9% NaCl + PHMB (n=22). CRP, PCT, and bacterial colonization were assessed pre-operatively and on postoperative day 14. Mann–Whitney tests were used for CRP and PCT, and Chi-square tests for bacterial colonization, with p<0.05 considered significant.
Results: Baseline (pre-operative) CRP (p=0.715), PCT (p=0.663), and bacterial colonization (p=0.930) did not differ significantly between groups. On postoperative day 14, the NaCl + PHMB group showed significantly lower CRP levels than the NaCl group (median 2.4 [2.0–3.0] vs 3.2 [2.4–5.0]; p<0.001) and significantly lower bacterial colonization (p<0.001). PCT levels on day 14 were not significantly different between groups (median 0.09 vs 0.15; p=0.621).
Conclusion: Debridement using combined 0.9% NaCl + PHMB irrigation is more effective in reducing CRP and bacterial colonization on postoperative day 14 compared with 0.9% NaCl alone, while no significant difference was observed in PCT levels.
Keywords: open fracture, cruris, debridement, irrigation, PHMB, CRP, procalcitonin, bacterial colonization.
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