Infected nonunion with implant In Situ in long bone fractures, managed by retention of implant-our experience

Gill, Sps; Raj, Manish; Singh, Pooja; Kumar, Dinesh; Singh, Jasveer; Rastogi, Prateek

doi:10.4103/0975-7341.207164

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…However, it remains unknown if severity of infection and bone-healing is worse in osteoporotic bone with FRI. Clinically, the current consensus is to retain the implant if fixation is stable, as early implant removal will cause soft-tissue damage and worsening of infection. 21 One recent animal study also showed that instability leads to more pronounced local immune responses in a FRI model. 40 Despite the moderate effect of systemic antibiotic treatment on bacteria eradication and fracture-healing, its effect on FRI in osteoporosis also remains poorly understood.…”

Section: Discussionmentioning

confidence: 99%

“…7,20 The major difficulty for FRI treatment is therefore eradicating the biofilm formed on the implant, as well as the colony-forming units (CFUs) in the OLCN. 18,21 It remains unknown whether systemic antibiotics can effectively treat and promote healing in osteoporotic bone with FRI. 22 This study aims to assess: 1) whether osteoporotic bone with FRI presents with more severe infection compared to normal bone with FRI; and 2) fracture healing and the effect of systemic antibiotics on pathogen clearance in both osteoporotic and normal bone with FRI.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fracture-related infection in osteoporotic bone causes more severe infection and further delays healing

Wong

Chung

et al. 2022

Bone & Joint Research

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Aims With the ageing population, fragility fractures have become one of the most common conditions. The objective of this study was to investigate whether microbiological outcomes and fracture-healing in osteoporotic bone is worse than normal bone with fracture-related infection (FRI). Methods A total of 120 six-month-old Sprague-Dawley (SD) rats were randomized to six groups: Sham, sham + infection (Sham-Inf), sham with infection + antibiotics (Sham-Inf-A), ovariectomized (OVX), OVX + infection (OVX-Inf), and OVX + infection + antibiotics (OVX-Inf-A). Open femoral diaphysis fractures with Kirschner wire fixation were performed. Staphylococcus aureus at 4 × 104 colony-forming units (CFU)/ml was inoculated. Rats were euthanized at four and eight weeks post-surgery. Radiography, micro-CT, haematoxylin-eosin, mechanical testing, immunohistochemistry (IHC), gram staining, agar plating, crystal violet staining, and scanning electron microscopy were performed. Results Agar plating analysis revealed a higher bacterial load in bone (p = 0.002), and gram staining showed higher cortical bone colonization (p = 0.039) in OVX-Inf compared to Sham-Inf. OVX-Inf showed significantly increased callus area (p = 0.013), but decreased high-density bone volume (p = 0.023) compared to Sham-Inf. IHC staining showed a significantly increased expression of TNF-α in OVX-Inf compared to OVX (p = 0.049). Significantly reduced bacterial load on bone (p = 0.001), enhanced ultimate load (p = 0.001), and energy to failure were observed in Sham-Inf-A compared to Sham-Inf (p = 0.028), but not in OVX-Inf-A compared to OVX-Inf. Conclusion In osteoporotic bone with FRI, infection was more severe with more bone lysis and higher bacterial load, and fracture-healing was further delayed. Systemic antibiotics significantly reduced bacterial load and enhanced callus quality and strength in normal bone with FRI, but not in osteoporotic bone. Cite this article: Bone Joint Res 2022;11(2):49–60.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fracture-related infection in osteoporotic bone causes more severe infection and further delays healing

Wong

Chung

et al. 2022

Bone & Joint Research

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“…Bone healing may take a few weeks and sometimes several months, impacting the quality of life. Infection post-surgery is challenging to handle, making patient life even harder [ 2 ]. Bone tissues are unique as they can heal themselves after damage.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Analysis of a Biodegradable Magnesium Alloy Implant in an Animal Model Using Near-Infrared Spectroscopy

Mathew

Hassan

Korostynska

et al. 2023

Sensors

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Biodegradable magnesium-based implants offer mechanical properties similar to natural bone, making them advantageous over nonbiodegradable metallic implants. However, monitoring the interaction between magnesium and tissue over time without interference is difficult. A noninvasive method, optical near-infrared spectroscopy, can be used to monitor tissue’s functional and structural properties. In this paper, we collected optical data from an in vitro cell culture medium and in vivo studies using a specialized optical probe. Spectroscopic data were acquired over two weeks to study the combined effect of biodegradable Mg-based implant disks on the cell culture medium in vivo. Principal component analysis (PCA) was used for data analysis. In the in vivo study, we evaluated the feasibility of using the near-infrared (NIR) spectra to understand physiological events in response to magnesium alloy implantation at specific time points (Day 0, 3, 7, and 14) after surgery. Our results show that the optical probe can detect variations in vivo from biological tissues of rats with biodegradable magnesium alloy “WE43” implants, and the analysis identified a trend in the optical data over two weeks. The primary challenge of in vivo data analysis is the complexity of the implant interaction near the interface with the biological medium.

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Fabrication of substituted hydroxyapatite-starch-clay bio-composite coated titanium implant for new bone formation

Prabakaran

Rajan

Geng

et al. 2021

Carbohydrate Polymers

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Infected nonunion with implant In Situ in long bone fractures, managed by retention of implant-our experience

Cited by 3 publications

References 25 publications

Fracture-related infection in osteoporotic bone causes more severe infection and further delays healing

Fracture-related infection in osteoporotic bone causes more severe infection and further delays healing

In Vivo Analysis of a Biodegradable Magnesium Alloy Implant in an Animal Model Using Near-Infrared Spectroscopy

Fabrication of substituted hydroxyapatite-starch-clay bio-composite coated titanium implant for new bone formation

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