Adjuvant Local Antibiotic Hydroxyapatite Bio-Composite in the management of open Gustilo Anderson IIIB fractures. Prospective Review of 80 Patients from the Manchester Ortho-Plastic Unit

Aljawadi, Ahmed; Islam, Amirul; Jahangir, Noman; Niazi, Noman; Ferguson, Zak; Sephton, B.M.; Elmajee, Mohammed; Reid, Adam J.; Wong, Jason; Pillai, Anand

doi:10.1016/j.jor.2020.01.012

Cited by 10 publications

(10 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One of the most feared complications in orthopedic surgery is the bacterial colonization of abiotic surfaces causing PJI and FRI, occurring in 1% to 2% of the patients receiving orthopedic implants [23]. Antibiotic-eluting BGS represent an attractive clinical option in the management of PJI and FRI. Gentamicin-loaded ceramic fillers have been extensively employed in clinics and their successful use reported in the literature [20][21][22][24][25][26][27][28]. The increasing emergence of aminoglycoside resistance has led to the development of a new BGS formulation enriched with vancomycin, an additional option alongside gentamicin in the orthopedic field [29].…”

Section: Discussionmentioning

confidence: 99%

“…Since open fractures might be contaminated by Gram-positive and Gram-negative bacteria [31], the shown effect of CG on P. aeruginosa might be beneficial in this setting. Aljawadi and co-workers recently presented their clinical results on the use of CG in addition to systemic antibiotics in Gustilo-Anderson IIIb open fractures in a single-stage "Fix and Flap" procedure in 80 patients [24]. The limb salvage rate in this challenging patient group was 96.25% and the infection rate was 1.25%.…”

Section: Bacterial Adhesionmentioning

confidence: 99%

See 1 more Smart Citation

In Vitro Evaluation of Gentamicin or Vancomycin Containing Bone Graft Substitute in the Prevention of Orthopedic Implant-Related Infections

Bidossi

Bottagisio

Logoluso

et al. 2020

IJMS

View full text Add to dashboard Cite

Antibiotic-loaded bone graft substitutes are attractive clinical options and have been used for years either for prophylaxis or therapy for periprosthetic and fracture-related infections. Calcium sulfate and hydroxyapatite can be combined in an injectable and moldable bone graft substitute that provides dead space management with local release of high concentrations of antibiotics in a one-stage approach. With the aim to test preventive strategies against bone infections, a commercial hydroxyapatite/calcium sulfate bone graft substitute containing either gentamicin or vancomycin was tested against Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa, harboring different resistance determinants. The prevention of bacterial colonization and biofilm development by selected microorganisms was investigated along with the capability of the eluted antibiotics to select for antibiotic resistance. The addition of antibiotics drastically affected the ability of the selected strains to adhere to the tested compound. Furthermore, both the antibiotics eluted by the bone graft substitutes were able to negatively impair the biofilm maturation of all the staphylococcal strains. As expected, P. aeruginosa was significantly affected only by the gentamicin containing bone graft substitutes. Finally, the prolonged exposure to antibiotic-containing sulfate/hydroxyapatite discs did not lead to any stable or transient adaptations in either of the tested bacterial strains. No signs of the development of antibiotic resistance were found, which confirms the safety of this strategy for the prevention of infection in orthopedic surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Bacterial Adhesionmentioning

confidence: 99%

In Vitro Evaluation of Gentamicin or Vancomycin Containing Bone Graft Substitute in the Prevention of Orthopedic Implant-Related Infections

Bidossi

Bottagisio

Logoluso

et al. 2020

IJMS

View full text Add to dashboard Cite

show abstract

“…However, only 5% of the patients had bone defects larger than 5 cm. In these cases, a limb shortening of 4 cm was performed, and 88.3% of the patients achieved primary fracture union [ 36 ]. Recently, contradictory results have also been published.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of an Antibiotic Loaded Ceramic-Based Bone Graft Substitute for the Treatment of Infected Non-Unions

et al. 2022

View full text Add to dashboard Cite

The treatment of non-unions is often complicated by segmental bone defects and bacterial colonization. Because of the limited availability of autologous bone grafts, tissue engineering focuses on antibiotic-loaded bone graft substitutes. HACaS+G is a resorbable calcium sulphate-hydroxyapatite loaded with gentamicin. The osteoinductive, osteoconductive, and anti-infective effect of HACaS+G has already been demonstrated in clinical studies on patients with chronic osteomyelitis. However, especially for the treatment of infected non-unions with segmental bone defects by HACaS+G, reliable clinical testing is difficult and sufficient experimental data are lacking. We used an already established sequential animal model in infected and non-infected rat femora to investigate the osteoinductive, osteoconductive, and anti-infective efficacy of HACaS+G for the treatment of infected non-unions. In biomechanical testing, bone consolidation could not be observed under infected and non-infected conditions. Only a prophylactic effect against infections, but no eradication, could be verified in the microbiological analysis. Using µ-CT scans and histology, osteoinduction was detected in both the infected and non-infected bone, whereas osteoconduction occurred only in the non-infected setting. Our data showed that HACaS+G is osteoinductive, but does not have added benefits in infected non-unions in terms of osteoconduction and mechanical bone stability, especially in those with segmental bone defects.

show abstract

“…4 Deep infection is considered a proxy of poor outcome or treatment failure that can lead to limb loss. 1,11,12 Deep infections typically require further surgery combined with prolonged antimicrobial therapy but can be prevented by early and adequate débridement. [13][14][15] We reviewed compliance with the BOAST 4 guidelines during treatment of patients presenting to Oxford University Hospitals with complex open lower-limb injuries (Gustilo-Anderson IIIB or IIIC) over a 2-year period.…”

Section: Ementioning

confidence: 99%

mentioning

confidence: 99%

Orthoplastic Treatment of Open Lower-Limb Fractures Improves Outcomes: A 12-Year Review

D'Cunha¹,

Penn-Barwell

McMaster

et al. 2022

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Background: The British Orthopaedic Association Standards for Orthopaedics and Trauma 4 (BOAST 4) inform the management of open lower-limb fractures. The authors conducted repeated reviews of performance against these standards over a 12-year period. This latest iteration has shown further improvements in outcomes concomitant with changes in service delivery. Methods: Data on Gustilo-Anderson grade IIIB or IIIC open lower-limb fractures were collected from a prospectively constructed departmental database and analyzed using Excel. Outcomes assessed included time to stabilization, time to definitive soft-tissue coverage, and deep infection rates. Results A total of 69% of patients in our cohort received care that aligned with BOAST 4 guidelines. Median time to stabilization was 14.2 hours and to soft-tissue coverage was 47 hours, with 71% of cases compliant with BOAST 4 guidelines. The overall deep infection rate was 6.5% in our cohort. There was a significantly lower deep infection rate in BOAST 4–compliant cases (2%) versus noncompliant cases (16%), respectively (P = 0.05). A total of 41 of 61 patients had fixation and soft-tissue coverage in a single operation (fix and flap), eight had staged operations, and 12 required local flap closure. There was no significant difference in deep infection rates among these approaches. Conclusions: Compliance with the BOAST 4 guidelines and time to definitive soft-tissue coverage have improved at our center since the last review. Deep infection rates were significantly lower in BOAST 4–compliant cases, further validating this approach. The fix and flap technique was introduced during the study period and reduces operative burden for patients. These results support a joint orthoplastic approach as the optimal management for these complex injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

show abstract

Adjuvant Local Antibiotic Hydroxyapatite Bio-Composite in the management of open Gustilo Anderson IIIB fractures. Prospective Review of 80 Patients from the Manchester Ortho-Plastic Unit

Cited by 10 publications

References 28 publications

In Vitro Evaluation of Gentamicin or Vancomycin Containing Bone Graft Substitute in the Prevention of Orthopedic Implant-Related Infections

In Vitro Evaluation of Gentamicin or Vancomycin Containing Bone Graft Substitute in the Prevention of Orthopedic Implant-Related Infections

Efficacy of an Antibiotic Loaded Ceramic-Based Bone Graft Substitute for the Treatment of Infected Non-Unions

Orthoplastic Treatment of Open Lower-Limb Fractures Improves Outcomes: A 12-Year Review

Contact Info

Product

Resources

About