The findings could lead to significant cost savings, particularly in developing countries where open fractures are particularly common, researchers including one of Indian-origin said. As part of the study by McMaster University in Canada, 2,400 people with open arm or leg fractures had their wounds cleaned with either soap and water, or a saline water solution, and one of three different levels of water pressure.

Patients were monitored to see who would need to have an additional operation within 12 months because of infection or problems with wound healing. The researchers found that very low water pressure was an acceptable, low-cost alternative for washing out open fractures, and that the reoperation rate was higher in the group that used soap.

"There has been a lot of controversy about the best way to clean the dirt and debris from serious wounds with bone breaks," said Mohit Bhandari, principal investigator and a professor of surgery at McMaster University.

The study involved patients across 41 sites in the US, Canada, Australia, Norway and India. The majority of patients were men in their 40s with a lower extremity fracture, and the most common reason for the injury was a motor vehicle accident. The findings were published in the New England Journal of Medicine.

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