Introduction: Fracture-related infections (FRIs) are challenging for orthopedic surgeons, as conventional surgical treatment and systemic antimicrobial therapy cannot completely control local infections. Continuous local antibiotic perfusion (CLAP) is a novel and innovative therapy for bone and soft-tissue infections, and is expected to eradicate biofilms by maintaining a sustained high concentration of antimicrobial agents at the infected site. If CLAP therapy can eradicate infection even in cases with implants while preserving the implants, it would be an ideal and effective treatment for local refractory infections. This study aimed to evaluate the usefulness of novel CLAP therapy for FRIs. Methods: Nine patients treated with CLAP therapy were retrospectively analyzed. The mean age was 65.9 (43-82) years, and the mean followup period was 14.9 (6-45) months. In all cases, the infected sites were related to the lower
We report a case of rapidly progressive osteolysis and a very large cystic lesion that destroyed the inner table of the iliac bone following cementless total hip arthroplasty (THA). A 59-year-old female patient developed left hip pain at 11 years after THA. Osteolysis surrounding the acetabular cup was pointed out. She was brought to our hospital by ambulance due to severe left hip pain at 12 years after THA. Computed tomography (CT) showed that a cystic lesion in the pelvic cavity had destroyed the inner table of the iliac bone. Magnetic resonance imaging (MRI) showed a high signal intensity area of the hemorrhagic cystic lesion in the iliac bone in both T1-weighted and T2-weighted images. She underwent a liner and femoral head exchange, and required bone grafting and revision of the cup. The cystic lesion was removed and block-like allograft bone grafts were stuffed into the bone defects. If osteolysis and cystic lesions occur at the same time, not only the bone area around the implant but also a distant area like the inner table of the iliac bone may be destroyed. Additional tests such as CT or MRI may be useful to detect the presence of distant or cystic lesions. Early diagnosis and treatment are important because severe complications may occur in cases where osteolysis and cystic lesions coexist after THA.
The use of bioabsorbable implants that would negate the need for subsequent removal could offer major clinical advantages for the fixation of fractures. However, previous bioabsorbable plates have had several issues with regard to clinical usage. The aims of this study were to compare the mechanical properties of novel bioabsorbable plates with those of titanium plates in a fracture model and to demonstrate the clinical results of these new plates for hand fractures. Materials and Methods: The first set of experiments compared the mechanical properties of bioabsorbable and titanium plates. Two types of bioabsorbable plates made of hydroxyapatite/poly-L-lactide (1/3-and 1/2-circle in crosssection) and two types of titanium plates (for 1.5-and 2.0mm screws) were tested. Each plate was fixed on a polyether ether ketone (PEEK) rod, which was transversely cut at its midsection. The second part of the studies demonstrated the clinical results of bioabsorbable plates used in 62 cases of 70 hand fractures including 39 metacarpal, 20 distal ulna, 5 distal radius, and 6 radial head fractures since July 2008. The mean age of the patients was 48.4 years (range, 13-89). The follow-up period ranged from 3 month to 4 years 9 months. Results: The bending strength and stiffness of 1/3-circle bioabsorbable plate constructs were comparable with those of titanium plates for 1.5-mm screws, and those of 1/2-circle bioabsorbable plates were comparable with those of titanium plates for 2.0-mm screws. The torsional strength of 1/2-circle bioabsorbable plates (mean ± standard deviation: 79.0 ± 7.9 N⋅cm) was significantly greater than that of titanium plates for 2.0-mm screws (56.7 ± 4.0 N⋅cm; P < .05). The nonunion rate was 2.9% (2 cases in radial head fractures/70 cases). About 4.3% (3/70 cases) was necessary for implant removal because of loose screws in 2 cases of metacarpal fractures and limited range of motion in 1 case of radial head fracture. For the consecutive cases with metacarpal fractures, there were no significant differences in 6-month postoperative clinical results between patients receiving bioabsorbable plates after July 2008 and titanium plates before July 2008 (267.0 ± 6.0 vs 250.0 ± 28.3 degrees of total range of active motion, and 92.7 ± 19.7 vs 86.4 ± 28.6% of contralateral grip strength). Conclusions: The bending strength, stiffness, and torsional strength of novel 1/3-or 1/2-circle bioabsorbable plates, when fixed on a PEEK rod, were comparable with those for titanium plates for 1.5-or 2.0-mm screws. The clinical study of bioabsorbable plates used in hand fractures revealed satisfactory results for union rate, range of motion, and grip strength. For metacarpal fractures, there were no significant differences in clinical results between bioabsorbable and titanium plates.
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