Effectiveness of Local Antibiotic Delivery with an Osteoinductive and Osteoconductive Bone-Graft Substitute

Beardmore, Anthony A; Brooks, Daniel E.; Wenke, Joseph C.; Thomas, Darryl B.

doi:10.2106/jbjs.c.01670

Cited by 102 publications

(41 citation statements)

References 21 publications

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“…Despite the efforts to standardize the protocol, a large variation was present in quality of repair tissue and defect fill even though we used a sample size calculation that was based on previous studies [4,21,27,46]. The variation might be because the goats were not restricted in mobilization causing some goats to mobilize at a different pace [1].…”

Section: Discussionmentioning

confidence: 99%

“…The number of goats was determined from a sample size calculation performed using a power of 90% and two-sided significance level of 5% between groups. A 10% SD of the histology score was described by O'Driscoll et al [28]; therefore, a minimal effect of 15% was considered clinically significant [4,21]. Our study protocol was approved by the local animal welfare committees (ORCA102287).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Kok

Tuijthof

Dunnen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized. Questions/purposes We hypothesized (1) holes that reach deeper into the bone marrow-filled trabecular bone allow for more hyaline-like repair; and (2) a larger number of holes with a smaller diameter result in more solid integration of the repair tissue, less need for new bone formation, and higher fill of the defect. Methods Talar osteochondral defects that were 6 mm in diameter were drilled bilaterally in 16 goats (32 samples). In eight goats, one defect was treated by drilling six 0.45-mm diameter holes in the defect 2 mm deep; in the remaining eight goats, six 0.45-mm diameter holes were punctured to a depth of 4 mm. All contralateral defects were treated with three 1.1-mm diameter holes 3 mm deep, mimicking the clinical situation, as internal controls. After 24 weeks, histologic analyses were performed using Masson-Goldner/Safranin-O sections scored using a modified O'Driscoll histologic score (scale, 0-22) and analyzed for osteoid deposition. Before histology, repair tissue quality and defect fill were assessed by calculating the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The authors certify that the animal protocol for this investigation was approved by the Academic Medical Center and VU University, Amsterdam, and that all investigations were conducted in conformity with ethical principles of research. The design and creation of surgical templates was performed at TU Delft, Delft, The Netherlands. Animal operations were performed at VU University, Amsterdam, The Netherlands. Histology was performed at ACTA, Amsterdam, The Netherlands. Micro-CT acquisition and analyses were performed at Erasmus MC, Rotterdam, The Netherlands. Analyses were performed at Academic Medical Center, Amsterdam, The Netherlands. Conclusions The results indicate that the geometry of microfracture holes does not influence cartilage healing in the caprine talus. Clinical Relevance Bone marrow stimulation technique does not appear to be improved by changing the depth or diameter of the holes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Kok

Tuijthof

Dunnen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…No infections in the experimental arm contrasted with infections in all but one animals in both control arms of this study [122]. There exists therefore a possibility to provide enhanced osteoconductive and inductive scaffolds for bone regeneration in the same delivery vehicle for local antibiotic.…”

Section: Infection In Conflict Wounded-future Directions In Research mentioning

confidence: 69%

Infection in conflict wounded

Eardley

Brown

Bonner

et al. 2011

Phil. Trans. R. Soc. B

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Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.

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“…The size of the AMX molecule is ~0.8 nm [26], a reasonable size to enter and fill the 20 nm diameter pores and interstitial spaces in between the nanotubes. Preoperative oral administration of AMX has been proven to reduce the risk of implant failure [27,28], and local delivery of AMX during orthopedic surgery reduced the infections associated with open fractures [29], compound limb fractures [30], and with osteoinductive and osteoconductive bone-graft substitutes [29]. As well, local delivery of antibiotics was effective in reducing vascular infections from staphylococcal strains [31].…”

Section: Resultsmentioning

confidence: 99%