Bioactive-Coated Implants in Trauma Surgery

Abstract

Complications still occur in musculoskeletal surgery despite improvements in operating techniques and optimization of implants. Problems include delayed fracture healing, non-unions and extensive osseous infections. Growth factors for local application are in clinical use, but have not become widely accepted. Reasons may be that these proteins are expensive and of limited availability and considerable quantities have to be implanted locally. Coated implants incorporating active ingredients could release drugs locally and thereby generate a high concentration directly in the area of interest without systemic side effects. Compounds that could be used in this way include growth factors for the improvement of fracture healing and antibiotics for prophylaxis of implant-related infections. The biodegradable poly(D,L-lactide) coating of implants can facilitate the local controlled release of incorporated growth factors directly into the fracture and thus serves both as a fracture stabilization device and as a carrier for active components. This review presents different models (fracture healing; intervertebral fusion; infection model) demonstrating the efficiency of the coating technology. These findings seem to justify the transfer of this technology into clinical settings. In a preliminary study, gentamicin-coated intramedullary tibial nails were implanted in patients exhibiting fractures with severe soft tissue damage. The preliminary findings do not allow conclusions to be drawn in respect of therapy of fractures with severe soft tissue damage or revision surgery. However, the coating seems to be suitable as a "key technology" for the incorporation of active ingredients and might be helpful in revision arthroplasty.

Staphylococcus aureus-Associated Musculoskeletal Infections

“…The use of coated implants as another option of a drug delivery system has the opportunity to prevent biofilm synthesis and the development of implant-associated infections (Schmidmaier et al 2006). First studies and clinical experience with the use of coated implants reveal promising results to reduce and prevent implant-associated infections by this method (Fuchs et al 2008).…”

The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study

“…Intramedullary nailing is the method of choice for treating tibial shaft fractures [ 16 ]. However, tibial fractures with severe soft-tissue damage that results in the loss of soft-tissue support and disrupted vascularity are especially prone to infection, non-union and other complications [ 4 , 5 ]. Despite improvements in surgical techniques and the use of antibiotic therapy, deep wound infections and osteomyelitis remain serious complications that may lead to impaired healing, reduced limb function and life-threatening septic conditions [ 20 , 22 ].…”

Coatings Based on Two-Dimensionally Ordered Linear Chain Carbon for Protection of Titanium Implants from Microbial Colonization

“…В медицинских испытаниях использование интрамедуллярного фиксатора UTN PROtect показывало хорошие клинические, лабораторные и рентгенологические результаты через 6 мес. после имплантации, что позволило рекомендовать его как для профилактики инфекций, так и для купирования [26,27].…”