Modern principles for the treatment of open fractures include stabilisation of the bone and management of the soft tissues. Wound debridement and irrigation is thought to be the mainstay in reducing the incidence of infection. Although numerous studies on animals and humans have focused on the type of irrigation performed, little is known of the factors which influence irrigation. This paper evaluates the evidence, particularly with regard to additives and the mode of delivery of irrigation fluid. Normal saline should be used and although many antiseptics and antibiotics have been employed, no consensus has been reached as to the ideal additive. Despite the advocates of high-pressure methods highlighting the improved dilutional ability of such techniques, the results are inconclusive and these irrigation systems are not without complications. New systems for debridement are currently being investigated, and an ideal method has yet to be determined.

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Abstract. Aerosols influence the Earth’s energy balance through direct radiative effects and indirectly by altering the cloud micro-physics. Anthropogenic aerosol emissions dropped considerably when the global COVID–19 pandemic resulted in severe restraints on mobility, production, and public life in spring 2020. Here we assess the effects of these reduced emissions on direct and indirect aerosol radiative forcing over Europe, excluding contributions from contrails. We simulate the atmospheric com- position with the ECHAM5/MESSy Atmospheric Chemistry (EMAC) model in a baseline (business as usual) and a reduced emission scenario. The model results are compared to aircraft observations from the BLUESKY aircraft campaign performed in May/June 2020 over Europe. The model agrees well with most of the observations, except for sulfur dioxide, particulate sulfate and nitrate in the upper troposphere, likely due to a somewhat biased representation of stratospheric aerosol chemistry and missing information about volcanic eruptions which could have influenced the campaign. The comparison with a business as usual scenario shows that the largest relative differences for tracers and aerosols are found in the upper troposphere, around the aircraft cruise altitude, due to the reduced aircraft emissions, while the largest absolute changes are present at the surface. We also find an increase in shortwave radiation of 0.327 ± 0.105 Wm−2 at the surface in Europe for May 2020, solely attributable to the direct aerosol effect, which is dominated by decreased aerosol scattering of sunlight, followed by reduced aerosol absorption, caused by lower concentrations of inorganic and black carbon aerosols in the troposphere. A further in- crease in shortwave radiation from aerosol indirect effects was found to be much smaller than its variability. Impacts on ice crystal- and cloud droplet number concentrations and effective crystal radii are found to be negligible.

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