Background Patients with severe lower extremity trauma have significant disability 2 years after injury that worsens by 7 years. Up to 15% seek late amputation. Recently, an energy-storing orthosis demonstrated improved function compared with standard orthoses; however, the effect when integrated with rehabilitation over time is unknown.

BackgroundImplant-related osteomyelitis is a major complication that requires immediate treatment, often involving removal of the implant, prolonging patient recovery and inflating expenses. Current research involving interventions to diminish the prevalence of such measures include investigating prophylactic and therapeutic remedies. A proper and accurate animal model is needed to thoroughly investigate such treatments. The scope of this project was to develop an animal model in which a consistent and measurable infection can be formed on an orthopedic implant when bacteria is introduced via a hematogenous source.MethodsTitanium Kirschner-wires were implanted into the intramedullary canals of both femurs. Staphylococcus aureus, ranging from104 to 109 colony forming units, was injected into a tail vessel. After a designated time (3, 7, 14, or 42 days) the femurs were harvested and bacterial numbers determined for both the femur and the implanted K-wire. In addition, histology and micro-computed tomography were used as subjective tools to further characterize the infection.ResultsConsistent infection, that is infection of ≥75 % of the femurs, wasn’t achieved until 107 CFU S. aureus was injected. At 107 CFU, the femurs contained 4.6x106 CFU/g bone tissue at day 3 and 4.8×108 CFU/g bone tissue by day 14. The wire showed comparable contamination with 4.8×104 CFU/mm2 at day 3 and 3.7×105/mm2 by day 14. After 42 days, the bacteria number decreased but was still occupying at 1.9×105 CFU/g bone tissue. There were morphological changes to the bone as well. At day 42, there were signs of osteonecrosis and active bone formation when compared to control animals that received a K-wire but were inoculated with saline.ConclusionsA model for hematogenous osteomyelitis, a common complication associated with implants, has been introduced. A reproducible, preclinical model is essential to evaluate future methods used to mitigate blood-borne bacteria hardware and bone infections.

Increased bone density at 6 months postoperatively in patients who had surface replacement arthroplasties provides evidence that clinically relevant stress shielding does not occur after surface replacement arthroplasty. Owing to the increased bone mineral density at 6 months, we believe patients who underwent surface replacement arthroplasties may to return to high-impact activities at that time without increased risk of fracture.

Therapeutic, Level V.

Fasciotomy of the foot did not prevent neuropathic pain and deformities in patients with FCS in this study.