scholarly journals Custom-Made Antibiotic Cement-Coated Nail for the Treatment of Infected Bone Defect

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Guoliang Wang ◽  
Wen Luo ◽  
Yong Zhou ◽  
Zhenfeng Zhu ◽  
Zihou Zhao ◽  
...  
Keyword(s):  
Infection Control ◽  
Bone Healing ◽  
Bone Defects ◽  
Long Bone ◽  
Antibiotic Cement ◽  
Sf 36 ◽  
Custom Made ◽  
Printing Technique ◽  
3D Printing Technique

Background. Longbone infected bone defect remains a great challenge due to multiple surgeries, long-term treatment duration, and uncertain prognosis. Treatment principles include eradication/debridement, stabilization, and antibiotic administration. An antibiotic cement-coated nail has shown great prospects due to both local antibiotic elution and stabilization of bone defects. However, the current fabrication technique remains to be improved. Methods. For the first time, we described a new method for custom-made cement-coated nail fabrication based on a 3D printing technique. A retrospective study of 19 consecutive patients with long bone infected bone defects from one medical center was conducted who met the inclusion and exclusion criteria from November 2016 to May 2020. The treatment involved thorough debridement, custom-made antibiotic cement-coated nail filling, and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Clinical and radiographic examinations (X-ray and CT scans) were used to evaluate bony union. Clinical and laboratory examinations were used to evaluate the infection control. The SF-36 score was used to evaluate patients’ quality of life pre- and postoperatively. Results. The mean follow-up was 98.8 weeks (ranging from 40 to 192). All cases achieved infection control, 3 cases achieved bone healing after one-stage operation, and 12 cases achieved bone healing after a two-stage bone graft procedure. At the last follow-up, none of the 19 patients had infection recurrence or 1 case had failure of the protective plate. The pre- and postoperative SF-36 score showed that there were statistical differences in all the 9 aspects. Conclusions. The precise custom-made antibiotic cement-coated intramedullary nail through the 3D printing technique used in this study is an effective strategy for the treatment of infected bone defects of long bone. This technique may help to increase the infection control rate and promote bone healing.

scholarly journals Bone transport with magnetic intramedullary nails in long bone defects

2020 ◽  
Author(s):  
Selina Summers ◽  
Matija Krkovic
Keyword(s):  
Varus Deformity ◽  
Bone Defects ◽  
Bone Transport ◽  
Long Bone ◽  
Diaphyseal Bone ◽  
Sf 36 ◽  
Bone Segment ◽  
The Mean ◽  
Bone Segment Transport

Abstract Background This study describes the outcomes of internal bone transport with magnetic nails in five cases of traumatic segmental femoral bone defects. Methods Five patients with open fracture of the femur and diaphyseal bone loss were included between May 2018 and August 2020. The mean femoral defect was 8.7 cm (range 5.6–16.0). Intervention We used plate-assisted bone segment transport (PABST) with PRECICE magnetic nails. Results All five patients have fully consolidated. The mean consolidation time and index were 7.5 months and 0.8 mo/cm, respectively. The mean follow-up was 21.3 months. The main complications were reduced knee ROM, mild varus deformity and plate bending. Post-operative SF-36, Oxford Knee scores and ED-5Q-5L scores were also compiled for four of five patients. SF-36 and Oxford Knee scores were reported without pre-injury data for comparison. ED-5Q-5L index and VAS were compared UK population norm and were both found to be statistically insignificant (p = 0.071 and p = 0.068, respectively). Conclusion Bone transport with magnetic nails has the capacity to obtain good functional recovery in long bone defects despite variable outcome pictures. In response to variable outcome reporting in the literature, we propose a standard reporting template for future studies to facilitate more rigorous analyses.

scholarly journals Two stage management of long bone infection by using an antibiotic cement-coated locking plate: an outcome of 183 cases

2019 ◽  
Author(s):  
Chao Jia ◽  
Xiaohua Wang ◽  
Shengpeng Yu ◽  
Hongri Wu ◽  
Jie Shen ◽  
...  
Keyword(s):  
Infection Control ◽  
Internal Fixation ◽  
Bone Grafting ◽  
Clinical Effect ◽  
Locking Plate ◽  
Lower Extremities ◽  
Bone Infection ◽  
Long Bone ◽  
Antibiotic Cement

Abstract Background The purpose of this study was to evaluate the clinical effect of antibiotic cement-coated locking plate as temporary internal fixation for the treatment of long bone infection in lower extremities . Methods Retrospective analysis the clinical data of 183 patients with lower extremities long bone infection admitted to our hospital from January 2013 to December 2017. All patients were treated with locking plate internal fixation after primary debridement. Antibiotic cement was used to fill the bone defect and wrap the plate. After infection control, bone grafting to reconstruct the bone defect. Results There were 81 cases of femur, 100 cases of tibia and 2 cases of fibula, after the first stage, 16(8.7%) patients had recurrence of infection after the first stage which have to debridement again. 4 tibial infecton patients had poor wound healing, 2 femoral patients had fixation failure, and 1 patient had femoral fracture due to fall down. After a mean time of 32.0 months (range 12 to 66) follow up, the recurrence rate of infection was 14.2% (26/183). Among them, eighteen patients underwent bone grafting after re-debridement, 6 patients received permanent placement of antibiotic bone cement after debridement, and 2 patients refused further treatment and chose amputation. Bone healing was achieved in 175(95.9%) patients in the last follow-up, and the average time of bone union was 5.4 months (range 4 to 12 months). Conclusions Temporary internal fixation with antibiotic cement coated locking plate has good clinical effect in the treatment of lower extremities long bone infection. It does not increase the difficulty of bone infection control. Pay attention to possible difficulty of skin coverage when applied in calves. Key words: Antibiotic cement coated locking plate, Bone infection, Internal fixation

scholarly journals Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Marcin K. Wasko ◽  
Rafal Kaminski
Keyword(s):  
Failure Mechanisms ◽  
Medullary Canal ◽  
Bone Infection ◽  
Long Bone ◽  
Current Evidence ◽  
Orthopaedic Trauma ◽  
Antibiotic Cement ◽  
Custom Made ◽  
Trauma Surgeons ◽  
Technique Failure

Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons’ hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection.

scholarly journals Preclinical studies on pleiotropic functions of erythropoietin on bone healing

2021 ◽  
Vol 24 (1) ◽  
pp. 1-11
Author(s):  
R. Vasileva ◽  
Ts. Chaprazov
Keyword(s):  
Bone Healing ◽  
Bone Defects ◽  
Long Bone ◽  
Preclinical Studies ◽  
Primary Interest ◽  
Glycoprotein Hormone ◽  
Angiogenic Potential ◽  
Femoral Head Osteonecrosis ◽  
Posterolateral Spinal Fusion ◽  
Pleiotropic Functions

Erythropoietin (ЕPО) is a glycoprotein hormone, mainly known for its haemopoietic function. For orthopaedics, its pleiotropic effects – osteogenic and angiogenic potential, are of primary interest. The exact mechanism of EPO action is still unclear. The effects of EPO on bone healing were investigated through experiments with rats, mice, rabbits and pigs. Each of used models for experimental bone defects (calvarial models, long bone segmental defects, posterolateral spinal fusion and corticosteroid-induced femoral head osteonecrosis) has specific advantages and flaws. Obtaining specific and correct results is largely dependent on the used model. The brief evaluation of models could serve for standardisation of preclinical studies on bone regeneration.

scholarly journals Excellent mid-term osseointegration and implant survival using metaphyseal sleeves in revision total knee arthroplasty

2020 ◽  
Vol 28 (12) ◽  
pp. 3843-3848 ◽  
Author(s):  
Sebastian M. Klim ◽  
Florian Amerstorfer ◽  
Gerwin A. Bernhardt ◽  
Patrick Sadoghi ◽  
Georg Hauer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Treatment Option ◽  
Knee Arthroplasty ◽  
Bone Defects ◽  
Revision Total Knee Arthroplasty ◽  
Sf 36 ◽  
Total Knee ◽  
Mid Term Results

Abstract Purpose Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. Methods Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone–sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. Results No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. Conclusion No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. Level of evidence Retrospective cohort study, level III.

scholarly journals Bone Marrow-Derived Cell Therapies to Heal Long-Bone Nonunions: A Systematic Review and Meta-Analysis—Which Is the Best Available Treatment?

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Silvia Palombella ◽  
Silvia Lopa ◽  
Silvia Gianola ◽  
Luigi Zagra ◽  
Matteo Moretti ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Healing ◽  
Healing Rate ◽  
Meta Analysis ◽  
Long Bone ◽  
Current Evidence ◽  
Positive Trend ◽  
Case Control Studies ◽  
Cell Therapies

Nonunions represent one of the major indications for clinical settings with stem cell-based therapies. The objective of this research was to systematically assess the current evidence for the efficacy of bone marrow-derived cell-based approaches associated or not with bone scaffolds for the treatment of nonunions. We searched MEDLINE (PubMed) and CENTRAL up to July 2019 for clinical studies focused on the use of cell-based therapies and bone marrow derivatives to treat bone nonunions. Three investigators independently extracted the data and appraised the risk of bias. We analysed 27 studies including a total number of 347 participants exposed to four interventions: bone marrow concentrate (BMAC), BMAC combined with scaffold (BMAC/Scaffold), bone marrow-derived mesenchymal stromal cells (BMSCs), and BMSC combined with scaffold (BMSC/Scaffold). Two controlled studies showed a positive trend in bone healing in favour of BMAC/Scaffold or BMSC/Scaffold treatment against bone autograft, although the difference was not statistically significant (RR 0.11, 95% CI -0.05; 0.28). Among single cohort studies, the highest mean pooled proportion of healing rate was reported for BMAC (77%; 95% CI 63%-89%; 107 cases, n=8) and BMAC/Scaffold treatments with (71%; 95% CI 50%-89%; 117 cases, n=8) at 6 months of follow-up. At 12 months of follow-up, an increasing proportion of bone healing was observed in all the treatment groups, ranging from 81% to 100%. These results indicate that BMAC or BMAC/Scaffold might be considered as the primary choice to treat nonunions with a successful healing rate at a midterm follow-up. Moreover, this meta-analysis highlighted that the presence of a scaffold positively influences the healing rate at a long-term follow-up. More case-control studies are still needed to support the clinical improvement of cell-based therapies against autografts, up to now considered as the gold standard for the treatment of nonunions.

Clinical and radiological assessment of the induced membrane technique using beta-tricalcium phosphate in reconstructive surgery for lower extremity long bone defects

2021 ◽  
Vol 103-B (3) ◽  
pp. 456-461
Author(s):  
Gen Sasaki ◽  
Yoshinobu Watanabe ◽  
Youichi Yasui ◽  
Mari Nishizawa ◽  
Natsumi Saka ◽  
...  
Keyword(s):  
Bone Healing ◽  
Bone Defects ◽  
Defect Size ◽  
Lower Limbs ◽  
Second Stage ◽  
Beta Tricalcium Phosphate ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Segmental Bone

Aims To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (β-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. Methods A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using β-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. Results There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. Conclusion IMT using β-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456–461.

scholarly journals Antibiotic cement plate composite structure internal fixation after debridement of bone infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaohua Wang ◽  
Shulin Wang ◽  
Jianzhong Xu ◽  
Dong Sun ◽  
Jie Shen ◽  
...  
Keyword(s):  
Infection Control ◽  
Internal Fixation ◽  
Composite Structure ◽  
Bone Infection ◽  
Control Effect ◽  
Fixation Failure ◽  
Infection Control Rate ◽  
Antibiotic Cement ◽  
Epidermal Necrosis

AbstractAn internal fixation composite structure of antibiotic cement plates was created. The aim of this study was to analyse the infection control effect of this structure when applied to treat a bone infection. We retrospectively analysed patients with bone infection admitted to our hospital between January 2013 and June 2019. After debridement, an antibiotic cement plate composite structure was used to fill and stabilize the defects. The treatment effect was evaluated at six months after surgery, and the infection control rate, factors associated with the recurrence of infection, and complications were analysed. If the patients had bone defects, the defect was repaired after infection control, and the infection control rate of all of the patients was re-evaluated at 12 months after surgery. A total of 548 patients were treated with this technique, including 418 men and 130 women. The infection sites included 309 tibias, 207 femurs, 16 radii and ulnae, 13 humeri, and 3 clavicles. After at least 6 months of follow-up, 92 patients (16.79%) had an infection recurrence and needed further treatment. The recurrence rate of the tibia was higher than that of the femur (P = 0.025). Eighty-nine out of 92 patients who relapsed underwent a second debridement with the same method, and the infection control rate after the second debridement was 94.71%. Complications included 8 cases of epidermal necrosis around the incision, 6 cases of internal fixation failure, and 30 cases of lower limb swelling. By the follow-up time of 12 months, another 6 patients had experienced recurrence of infection, and 4 cases were controlled after debridement. Finally, among all 548 cases, 7 patients remained persistently infected, and 6 underwent amputation. The infection control rate was 97.6% at the 1-year follow-up. The clinical efficacy of this new antibiotic cement plate composite structure for internal fixation after debridement of bone infection is stable and reliable.

scholarly journals Novel piston technique versus Ilizarov technique for the repair of bone defect after lower limb infection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiafei Du ◽  
Zifei Yin ◽  
Pengfei Cheng ◽  
Pei Han ◽  
Hao Shen
Keyword(s):  
Bone Healing ◽  
Lower Limb ◽  
Joint Stiffness ◽  
Functional Results ◽  
Bone Defects ◽  
Ilizarov Technique ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background We aimed to compare the effectiveness and complications of a novel piston technique versus the Ilizarov technique for the repair of bone defects after lower limb infection. Patients and methods We retrospectively reviewed 41 patients who had been treated at our department for lower extremity bone defects following osteomyelitis. There were 38 men and three women with a mean age of 43.41 (range, 12–69 years). The infected bone defects involved 36 tibias and five femurs. The piston technique (PT, group A) was used in 12 patients and the Ilizarov technique (IT, group B) in 29 patients. The mean follow-up period was 28.50 months (PT) and 29.90 months (IT). The modified Application of Methods of Illizarov (ASAMI) criteria was used to evaluate bone healing and functional recovery. Results Complete eradication of the infection and union of docking sites were accomplished in both groups. The mean external fixator index (EFI) was 42.32 days/cm in group A versus 58.85 days/cm in group B (p < 0.001). The bone outcomes were similar between groups A and B (p = 0.558) (excellent [9 vs. 19], good [3 vs.10]); group A showed better functional outcomes than group B (p < 0.05) (excellent [7 vs. 6], good [4 vs. 12], fair [0 vs. 10] and poor [1 vs. 1]). Pain was the most common complaint during follow-up, and group A had fewer cases of pin tract infection (1 vs. 6), adjacent joint stiffness (3 vs. 8), and delayed healing of the joint (0 vs. 3). Conclusions Satisfactory bone healing can be achieved by using both PT and IT, although PT demonstrated better functional results, lower EFI, and allowed early removal of the external fixation. We found that this novel piston technique can improve the comfort of patients, reduce the incidence of complications, and provide rapid and convenient rehabilitation.

scholarly journals The effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis – comparative analysis of custom-made versus commercially available nails

2021 ◽  
Vol 6 (9) ◽  
pp. 457-466
Author(s):  
Germán Garabano ◽  
Hernán del Sel ◽  
Joaquin Anibal Rodriguez ◽  
Leonel Perez Alamino ◽  
Cesar Angel Pesciallo
Keyword(s):  
Comparative Analysis ◽  
Infection Control ◽  
Failure Rate ◽  
Operating Time ◽  
Consecutive Series ◽  
Antibiotic Cement ◽  
Custom Made ◽  
Initial Injury ◽  
Post Traumatic ◽  
Reoperation Rates

Abstract. Background: The first objective of this retrospective study was to assess infection control rates in patients with chronic post-traumatic osteomyelitis (CPTO) of the femur or tibia treated with antibiotic cement-coated nails. The second objective was to compare the efficacy of custom-made nails versus commercially available antibiotic-coated nails in terms of infection control and need for reoperation. Methods: We reviewed a consecutive series of CPTO patients treated with antibiotic-coated nails who had a minimum follow-up of 24 months. We recorded the characteristics of the initial injury, the type of nail used, cement–nail debonding, infecting microorganisms, operating time, infection control, need for reoperation, and failure rate. We performed a comparative analysis between nails manufactured in the operating room (i.e., custom-made) and those commercially available. Results: Thirty patients were included. The affected bones were the femur (n=15) and the tibia (n=15). Twenty-one of the 30 initial injuries were open fractures. Staphylococcus aureus was the most frequently isolated microorganism (50 %). Sixteen patients were treated with custom-made nails and 14 with commercially available antibiotic-coated nails. At the time of extraction, four out of five custom-made antibiotic-coated nails experienced cement–bone debonding. Commercial nails were associated with shorter operating times (p<0.0001). The overall infection control rate was 96.66 %. Eight (26.66 %) patients needed reoperation. There was one failure (3.33 %) in the group treated with custom-made antibiotic-coated nails. We did not find significant differences between nail types in terms of reoperation, infection control, and failure rate. Conclusions: The use of antibiotic cement-coated nails proved useful in CPTO treatment. Commercially available nails had significantly shorter operating times and did not present cement–bone debonding during removal. Our results seem to indicate that both nail types are similar in terms of infection control and reoperation rates.

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