Influence of implant properties and local delivery systems on the outcome in operative fracture care

Metsemakers, Willem‐Jan; Moriarty, T. Fintan; Nijs, Stefaan; Pape, Hans-Christian; Richards, R. Geoff

doi:10.1016/j.injury.2016.01.019

Cited by 28 publications

(15 citation statements)

References 115 publications

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“…Although these materials meet the requirements of clinical application in terms of biocompatibility and mechanical properties, the incidence of fracture-related complications such as infection, delayed union, and nonunion remain a major clinical problem that further increases the suffering and financial burden of fracture patients. [7][8][9][10] Therefore, imparting antibacterial and/ or osteogenic properties to the existing metal implants is crucial for improving the prognosis of fracture and reducing postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Nano-copper-bearing stainless steel promotes fracture healing by accelerating the callus evolution process

Wang¹,

Li²,

Ren³

et al. 2017

IJN

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Treatment for fractures requires internal fixation devices, which are mainly produced from stainless steel or titanium alloy without biological functions. Therefore, we developed a novel nano-copper-bearing stainless steel with nano-sized copper-precipitation (317L-Cu SS). Based on previous studies, this work explores the effect of 317L-Cu SS on fracture healing; that is, proliferation, osteogenic differentiation, osteogenesis-related gene expression, and lysyl oxidase activity of human bone mesenchymal stem cells were detected in vitro. Sprague–Dawley rats were used to build an animal fracture model, and fracture healing and callus evolution were investigated by radiology (X-ray and micro-CT), histology (H&E, Masson, and safranin O/fast green staining), and histomorphometry. Further, the Cu 2+ content and Runx2 level in the callus were determined, and local mechanical test of the fracture was performed to assess the healing quality. Our results revealed that 317L-Cu SS did not affect the proliferation of human bone mesenchymal stem cells, but promoted osteogenic differentiation and the expression of osteogenesis-related genes. In addition, 317L-Cu SS upregulated the lysyl oxidase activity. The X-ray and micro-CT results showed that the callus evolution efficiency and fracture healing speed were superior for 317L-Cu SS. Histological staining displayed large amounts of fibrous tissues at 3 weeks, and cartilage and new bone at 6 weeks. Further, histomorphometric analysis indicated that the callus possessed higher osteogenic efficiency at 6 weeks, and a high Cu 2+ content and increased Runx2 expression were observed in the callus for 317L-Cu SS. Besides, the mechanical strength of the fracture site was much better than that of the control group. Overall, we conclude that 317L-Cu SS possesses the ability to increase Cu 2+ content and promote osteogenesis in the callus, which could accelerate the callus evolution process and bone formation to provide faster and better fracture healing.

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Section: Introductionmentioning

confidence: 99%

Nano-copper-bearing stainless steel promotes fracture healing by accelerating the callus evolution process

Wang¹,

Li²,

Ren³

et al. 2017

IJN

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“…Coating strategies combine the ability for prevention and treatment of fracture-and implant-related infections through local delivery of antibiotics, such as aminoglycosides (e.g., gentamicin) or antimicrobial peptides (as alternatives in light of the rise in antibiotic-resistant bacteria), and controlled release of osteoinductive bone growth agents (e.g., bone morphogenic protein-2 and -7) for enhancement of bone healing. [108][109][110][111] Recent studies are already starting to show this tendency. [112][113][114][115] A promising product already in the market is the Expert Tibia Nail PROtect option, which offers protection from bacterial colonization through a local antibiotic prophylaxis coating while maintaining the same technique and instrumentation as the uncoated nails.…”

Section: Future Insightsmentioning

confidence: 98%

Recent developments on intramedullary nailing: a biomechanical perspective

Rosa

Marta

Vaz

et al. 2017

Annals of the New York Academy of Sciences

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Combining contributions from engineering and medicine, we highlight the biomechanical turning points in the historical evolution of the intramedullary nailing stabilization technique and discuss the recent innovations concerning increase in bone-implant system stability. Following the earliest attempts, where stabilization of long bone fractures was purely based on intuition, intramedullary nailing evolved from allowing alignment and translational control through press-fit fixation to current clinical widespread acceptance marked by the mechanical linkage between nail and bone with interlocking screws that allow alignment, translation, rotation, and length control. In an attempt to achieve an optimum interfragmentary mechanical environment, recent improvements considered the impact of different biomaterials on bone-implant stiffness. Another strategy considered the increase in the structural stability through the reduction of the number of movements between the different components that constitute the bone-implant system. Intramedullary nail improvements will most likely benefit from merging mechanics and fracture-healing biology by combining surface engineering with sensor tools associated with the innovative progress in wireless technology and with bone-healing biological active agents. Future research should aim at better understanding the ideal mechanobiological environment for each stage of fracture healing in order to allow for intramedullary nail design that satisfies such requirements.

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“…Studies show that local administration of antibiotics could have a positive influence on infection prevention [67][68][69]. Local prophylaxis can be administered by cement spacers, which are made of polymethyl methacrylate (PMMA), collagens, coatings (e.g.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

“…Local prophylaxis can be administered by cement spacers, which are made of polymethyl methacrylate (PMMA), collagens, coatings (e.g. antibiotic-coated tibial nails) and hydrogels [69].…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

Prevention of fracture-related infection: a multidisciplinary care package

Metsemakers

Onsea

Neutjens

et al. 2017

International Orthopaedics (SICOT)

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Fracture-related infection (FRI) remains a challenging complication. It may result in permanent functional loss or even amputation in otherwise healthy patients. For these reasons, it is important to focus attention on prevention. In treatment algorithms for FRI, antibiotic stewardship programmes have already proved their use by means of a multidisciplinary collaboration between microbiologists, surgeons, pharmacists, infectious disease physicians and nursing staff. A similar approach, however, has not been described for infection prevention. As a first step towards achieving a multidisciplinary care package for infection prevention, this review summarises the most recent guidelines published by the World Health Organization (WHO) and US National Institutes of Health Centers for Disease Control and Prevention (CDC), primarily focusing on the musculoskeletal trauma patient. The implementation of these guidelines, together with close collaboration between infection control physicians, surgeons, anaesthesiologists and nursing staff, can potentially have a beneficial effect on the rate of FRI after musculoskeletal trauma surgery. It must be stated that most evidence presented here in support of these guidelines was not obtained from musculoskeletal trauma research. Although most preventive measures described in these studies can be generalised to the musculoskeletal trauma patient, there are still important differences with nontrauma patients that require further attention. Future research should therefore focus more on this very defined patient population and more specifically on FRI prevention.

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Influence of implant properties and local delivery systems on the outcome in operative fracture care

Cited by 28 publications

References 115 publications

Nano-copper-bearing stainless steel promotes fracture healing by accelerating the callus evolution process

Nano-copper-bearing stainless steel promotes fracture healing by accelerating the callus evolution process

Recent developments on intramedullary nailing: a biomechanical perspective

Prevention of fracture-related infection: a multidisciplinary care package

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