Children with open tibial fractures show significantly lower infection rates than adults: clinical comparative study

Chen, Hui; Chen, Shunyou; Shi, Yi; Lu, Yunan; Yu, Bin

doi:10.1007/s00264-018-3996-6

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…Depending on factors like location, time after surgery, or patient related risk factors, implant associated infections in arthroplasty/revision arthroplasty (up to 4/20%) and fracture repair (up to 7%; up to 40% for open fractures) represent a severe and prevailing complication in orthopedic surgery [ 1 – 4 ]. The implant surfaces provide conditions especially for biofilm-forming bacteria to adhere and colonize on these medical devices.…”

Section: Introductionmentioning

confidence: 99%

In vitro and in vivo accumulation of magnetic nanoporous silica nanoparticles on implant materials with different magnetic properties

et al. 2018

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BackgroundIn orthopedic surgery, implant-associated infections are still a major problem. For the improvement of the selective therapy in the infection area, magnetic nanoparticles as drug carriers are promising when used in combination with magnetizable implants and an externally applied magnetic field. These implants principally increase the strength of the magnetic field resulting in an enhanced accumulation of the drug loaded particles in the target area and therewith a reduction of the needed amount and the risk of undesirable side effects. In the present study magnetic nanoporous silica core–shell nanoparticles, modified with fluorophores (fluorescein isothiocyanate/FITC or rhodamine B isothiocyanate/RITC) and poly(ethylene glycol) (PEG), were used in combination with metallic plates of different magnetic properties and with a magnetic field. In vitro and in vivo experiments were performed to investigate particle accumulation and retention and their biocompatibility.ResultsSpherical magnetic silica core–shell nanoparticles with reproducible superparamagnetic behavior and high porosity were synthesized. Based on in vitro proliferation and viability tests the modification with organic fluorophores and PEG led to highly biocompatible fluorescent particles, and good dispersibility. In a circular tube system martensitic steel 1.4112 showed superior accumulation and retention of the magnetic particles in comparison to ferritic steel 1.4521 and a Ti90Al6V4 control. In vivo tests in a mouse model where the nanoparticles were injected subcutaneously showed the good biocompatibility of the magnetic silica nanoparticles and their accumulation on the surface of a metallic plate, which had been implanted before, and in the surrounding tissue.ConclusionWith their superparamagnetic properties and their high porosity, multifunctional magnetic nanoporous silica nanoparticles are ideal candidates as drug carriers. In combination with their good biocompatibility in vitro, they have ideal properties for an implant directed magnetic drug targeting. Missing adverse clinical and histological effects proved the good biocompatibility in vivo. Accumulation and retention of the nanoparticles could be influenced by the magnetic properties of the implanted plates; a remanent martensitic steel plate significantly improved both values in vitro. Therefore, the use of magnetizable implant materials in combination with the magnetic nanoparticles has promising potential for the selective treatment of implant-associated infections.Electronic supplementary materialThe online version of this article (10.1186/s12951-018-0422-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

In vitro and in vivo accumulation of magnetic nanoporous silica nanoparticles on implant materials with different magnetic properties

et al. 2018

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“…Similarly the mean waiting time for soft tissue recovery was lower in children leading the authors to conclude that children had the superior ability of soft tissue recovery compared to adults. 23 In hematopoietic cell transplantation, although children had 2.9-fold higher incidence of infections their outcome was 2.5-fold better compared to adults. 24 In idiopathic scoliosis, due to the natural progression of the curve severity once the Cobb angle surpasses 45 degrees, we encounter 2 distinct age groups of patients who would undergo corrective surgery.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients

Chan

Gani

Chung

et al. 2021

Global Spine Journal

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Study Design: Retrospective propensity score matching (PSM) study. Objective: To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). Methods: 425 female AIS and AdIS patients who were operated (between January 2015 to March 2020) using a dual attending surgeon strategy were stratified into G1 (AIS aged 10-16 years old) and G2 (AdIS > 20 years old). PSM analysis with one-to-one, nearest neighbor matching technique with match tolerance of 0.001 was used to matched 357 AIS patients to 68 AdIS patients. Operation duration, intraoperative blood loss (IBL), blood loss percentage, hemoglobin drift, blood salvaged, postoperative wound length, allogenic blood transfusion requirement, postoperative hospital stay, postoperative Cobb, correction rate and postoperative complications were documented and reported. Results: Following PSM, G1 and G2 each had 50 patients with comparable and balanced covariates. As anticipated, G2 patients were heavier, taller and had higher body mass index compared to G1 patients ( P < 0.05). We could not find any significant differences in the perioperative outcome comparing this 2 groups. AIS and AdIS patients had similar operation duration (125.9 ± 27.2 min vs 127.3 ± 37.8 min), IBL (749.8 ± 315.7 ml vs 723.8 ± 342.1 ml) and length of hospital stay (3.3 ± 0.4 days vs 3.5 ± 0.8 days) ( P > 0.05). Hemoglobin drift and amount of blood salvaged were comparable ( P > 0.05). G2 had stiffer curves. There was a trend toward a lower correction rate in G2 in the immediate postoperative period, however it did not reach statistical significance (61.8 ± 11.2% vs. 66.3 ± 11.6%, P = 0.051). No patients required blood transfusion and none had any postoperative complications. Conclusion: Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy.

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“…Each study was thoroughly reviewed, and study dates were used to stratify the data into 4 decades: 1977–1986, 8–18 1987–1996, 19–62 1997–2006, 63–111 2007–2017. 112–168 If the dates of studies overlapped between 2 decades, the article was placed into the decade in which it spent the most time, for example, a study with dates from 1984 to 1993 would go into the second decade 1987 to 1996.…”

Section: Methodsmentioning

confidence: 99%

“…Deep infections were defined as an infection that involves the deep soft tissues, for example, muscle and fascia. There had to be documentation that a positive culture was present, and 35 articles 8,16,19,21,23,33,39,42,43,45,53,55,61,62,65,66,70,74,82,89,93,101,105,109,112,114,[120][121][122]128,132,135,137,142,150,152,156,157,159 included specific results of the cultures for infections. These data were extracted and sorted by decades to show how the epidemiology of infection may have changed over the 4 decades.…”

Section: Data Collectionmentioning

confidence: 99%

Where Are We in 2022? A Summary of 11,000 Open Tibia Fractures Over 4 Decades

Castillo

Heiner

Meremikwu

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To determine the infection and nonunion rates for open tibia fracture treatment over the past 4 decades since the introduction of the Gustilo–Anderson (GA) open fracture classification. Data Sources: PubMed, Scopus, CINAHL, and Cochrane databases were reviewed using the PRISMA checklist for articles between 1977 and September 2018. Study Selection: One hundred sixty-one articles meeting the following inclusion criteria: English language, published between 1977 and 2018, reported infection rates, reported nonunion rates, and fractures classified by the GA open fracture criteria were selected. Data Extraction: All articles were thoroughly evaluated to extract infection and nonunion data for open tibia fractures. Data Synthesis: Due to variability in the data reviewed, statistical evaluation could not be reliably done. Results: 11,326 open tibia fractures were reported with 17% type I, 25.2% type II, 25.3% type IIIA, and 32.5% type IIIB/C. The average infection rate over 4 decades was 18.3%, with 24.3% superficial, 11.2% deep, and 14.7% pin tract. The infection rate by decade was 14% for 1977–1986, 16.2% for 1987–1996, 20.5% for 1997%–2006%, and 18.1% from 2007 to 2017. The overall nonunion rate was 14.1%. The nonunion rate was 13% for 1977–1986, 17% for 1987–1996, 12.8% for 1997%–2006%, and 12.3% for 2007–2017. Conclusions: This in-depth summary has demonstrated that the percentage rate for infections and nonunion has remained similar over the past 40 years. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Children with open tibial fractures show significantly lower infection rates than adults: clinical comparative study

Cited by 17 publications

References 20 publications

In vitro and in vivo accumulation of magnetic nanoporous silica nanoparticles on implant materials with different magnetic properties

In vitro and in vivo accumulation of magnetic nanoporous silica nanoparticles on implant materials with different magnetic properties

A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients

Where Are We in 2022? A Summary of 11,000 Open Tibia Fractures Over 4 Decades

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