No Difference in Short-term Postoperative Complication Rates Between Non-chilled and Chilled Saline Irrigation in Percutaneous Foot and Ankle Surgery

Background: The advent of minimally invasive percutaneous foot and ankle surgery techniques has helped to lower certain complication rates, including wound infection and nonunion. The percutaneous burr is the work horse to perform these procedures. One concern with burr usage is that heat generated from prolonged use may induce thermal injury to the bone and soft tissues, affecting healing and outcomes. It is in contention whether further chilling the irrigation fluid may affect postoperative complication rates. Thus, the objective of this study is to assess the impact of chilled vs non-chilled saline during burr use on percutaneous double osteotomy bunionectomy. Methods: Data were prospectively collected for 485 consecutive patients undergoing percutaneous double osteotomy bunionectomy at 2 separate facilities, treated with either non-chilled saline or chilled saline. Age, sex, complication rates, union rates and time to union data were collected. Categorical and numerical statistical analysis was performed. Results: A total of 442 patients (chilled = 220, non-chilled = 222) were included. The mean age (SD) for all patients was 50.93 (20.51). Median (IQR) time to union was 12 (2) weeks for the chilled saline group and 12 (1) weeks for the non-chilled saline group ( P = .11). Union rates were 100% in the chilled saline group and 100% in the non-chilled saline group ( P = 1). Complication rates were 1.36% (95% CI, 0.28%-3.93%) in the chilled saline group and 0.45% (95% CI, 0.01%-2.49%) in the non-chilled saline group ( P = 0.30). The complications seen in the chilled saline group included 1 superficial wound dehiscence and 2 delayed unions. The non-chilled saline group saw 1 case of painful hardware removal. Conclusion: Based on our results, no significant difference could be detected between chilled saline and non-chilled saline groups during burr use for percutaneous double osteotomy bunionectomy when comparing union times, union rates, and complication rates (all P > 0.05). Level of Evidence: Level II, prospective cohort study.