ObjectivesAs well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic prophylaxis is considered the benchmark in the management of open fractures and considerably reduces the risk of subsequent fracture-related infections (FRI). The direct application of antibiotics in the surgical field (local antibiotics) has been used for decades as additional prophylaxis in open fractures, although definitive evidence confirming a beneficial effect is scarce. The purpose of the present study was to review the clinical evidence regarding the effect of prophylactic application of local antibiotics in open limb fractures.MethodsA comprehensive literature search was performed in PubMed, Web of Science, and Embase. Cohort studies investigating the effect of additional local antibiotic prophylaxis compared with systemic prophylaxis alone in the management of open fractures were included and the data were pooled in a meta-analysis.ResultsIn total, eight studies which included 2738 patients were eligible for quantitative synthesis. The effect of antibiotic-loaded poly(methyl methacrylate) beads was investigated by six of these studies, and two studies evaluated the effect of local antibiotics applied without a carrier. Meta-analysis showed a significantly lower infection rate when local antibiotics were applied (4.6%; 91/1986) than in the control group receiving standard systemic prophylaxis alone (16.5%; 124/752) (p < 0.001) (odds ratio 0.30; 95% confidence interval 0.22 to 0.40).ConclusionThis meta-analysis suggests a risk reduction in FRI of 11.9% if additional local antibiotics are given prophylactically for open limb fractures. However, due to limited quality, heterogeneity, and considerable risk of bias, the pooling of data from primary studies has to be interpreted with caution.Cite this article: M. Morgenstern, A. Vallejo, M. A. McNally, T. F. Moriarty, J. Y. Ferguson, S. Nijs, WJ. Metsemakers. Bone Joint Res 2018;7:447–456. The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis. DOI: 10.1302/2046-3758.77.BJR-2018-0043.R1

Aim:To establish the dynamics of C. furcoides in horizontal and temporal scales; and to determine the main ecological factors related to its dynamics. Methods: Samples were taken in five stations between July 2002 and July 2003. Physical and chemical variables were sampled monthly. Density was evaluated by sampling carried out within the photic zone. Growth rate (r), Turnover rate (T), Generation Time (gt), Niche Width (NW), Taylor's Power Law, and the rate of population change (σ s ), were used. Canonical Correspondence Analysis (CCA) was used too. . The first three components of CCA explained 92.2% of the variation. Density was positively associated with chlorophyll a, NH 4 + , RWCS and wind direction. Light attenuation, NO 3 -, SiO 2 and O 2 were negatively associated with C. furcoides. Discussion: C. furcoides is a S strategist; it increases its density in the warmest periods under eutrophic conditions, low light penetration and high thermal stability; it is independent of the temperature but dependent of changes in rainfall and nutrients, -especially nitrogen -and not soluble phosphorus. Up Río Chico presented the best conditions for the increase of C. furcoides, since this station presented the highest levels of total nitrogen, and the highest relative stability. Conclusion: C. furcoides has a very similar ecology to that of C. hirundinella. It is an organism highly variable in temporal and spatial scales, with a wide niche and a clustered distribution. It belongs to the Morpho-funtional Group V and to L o and L M Assotiations.Keywords: Ceratium furcoides, phytoplankton, dinoflagellates, temporal and spatial dynamics, tropical reservoir.Resumo: Objetivo: determinar a dinâmica de C. furcoides em escalas horizontal e temporal, e determinar os principais fatores ecológicos relacionados com sua dinâmica. Métodos: As amostras foram coletadas em cinco estações entre julho de 2002 e julho de 2003. As variáveis físicas e químicas foram amostrados mensalmente e a densidade foi estimada a través de coletas realizadas dentro da zona fótica, a taxa de crescimento (r), taxa de rotatividade (T), Tempo de Geração (GT), Largura do nicho (NW), Power Taylor's Law, e a taxa de mudança da população (σ s ) foram utilizados.

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Objectives: Open fractures are at significant risk of developing a fracture-related infection, despite the routine administration of perioperative antibiotic prophylaxis. Early application of antibiotic prophylaxis is known to reduce infection rates; however, most international guidelines focus on postoperative duration rather than prehospital administration. We compared conventional perioperative prophylaxis against early prehospital prophylaxis either as a systemic single shot of cefuroxime or a locally applied gentamicin-loaded hydrogel in a laboratory animal model. Methods: Thirty New Zealand white rabbits underwent a first surgical procedure to create an open wound, bone damage and contamination with Staphylococcus aureus. After a 4-hour observation period mimicking the time-to-treatment, the animals underwent a second procedure to irrigate the wound and apply a fracture fixation device. The 5 groups (n = 6 per group) received (1) no treatment; (2) conventional 24-hour cefuroxime; (3) an early single shot of cefuroxime 15 minutes after trauma; (4) a combined early and standard systemic prophylaxis; and (5) early application of a gentamicin-loaded hydrogel that was removed during irrigation. Results: Untreated animals displayed high numbers of bacteria in irrigation fluid and were all highly culture positive at euthanasia. Three of 6 animals were culture positive at euthanasia after conventional prophylaxis. Early systemic prophylaxis reduced bacterial burden in irrigation fluid by up to 100-fold, but 5/6 animals were culture positive at euthanasia. The combined prophylaxis displayed greater efficacy with only 1/6 rabbits culture positive at euthanasia. Local application of the gentamicin-loaded hydrogel reduced bacteria recovered by irrigation to just above our detection limit, and at euthanasia, all animals were culture negative at euthanasia. Conclusions: Early systemic antibiotic administration can significantly reduce bacterial burden in the operative field and reduce culture positivity at euthanasia when continued for 24 hours after injury. The early application of a gentamicin-loaded hydrogel that was removed during irrigation displayed superior efficacy to early systemic therapy alone and postoperative conventional gold standard 24-hour systemic therapy alone. These experimental results highlight the importance of early antibiotic administration in fracture care.