Our study may have implications for the care
of patients with open fractures worldwide and
may inform protocols for the management of
wound irrigation for paramedics, nurses, emergency
physicians, and surgeons caring for patients
with open fractures. Our findings may be
particularly relevant for low-income and middleincome
countries, in which 90% of the road
traffic fatalities globally, and probably a similar
percentage of open fractures, occur.41 In such
contexts, the knowledge that there is no benefit
to the use of irrigation-pressure devices can
guide the allocation of limited resources — a
result that is also very important for the management
of open fractures in combat settings