Infection after intramedullary nailing: An experimental investigation on rabbits

Melcher, GA; Hauke, C.; Metzdorf, Alexander; Perren, S. M.; Printzen, Gert; Schlegel, U.; Ziegler, Walter J.

doi:10.1016/0020-1383(96)89028-0

Cited by 27 publications

(31 citation statements)

References 7 publications

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“…The difference in infection susceptibility between these metals has been a topic of research for over 20 years [9]. Experimental data in animal studies have indicated that titanium is superior to Electropolished Stainless Steel (EPSS) with regard to infection susceptibility [4,6,10] and this has generally been attributed to superior biocompatibility of titanium and the observation that fibrous capsules tend to form around EPSS implants. A small number of clinical studies [11][12][13][14] …”

Section: Introductionmentioning

confidence: 99%

Titanium and steel fracture fixation plates with different surface topographies: Influence on infection rate in a rabbit fracture model

Metsemakers

Schmid

Zeiter

et al. 2016

Injury

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Section: Introductionmentioning

confidence: 99%

Titanium and steel fracture fixation plates with different surface topographies: Influence on infection rate in a rabbit fracture model

Metsemakers

Schmid

Zeiter

et al. 2016

Injury

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“…The metallic devices increase the likelihood of infection by providing a base for the formation of a biofilm layer; however, these osteosynthesis devices provide vital stability for fracture union [10,18,20]. Because of these competing concerns, two possible approaches can be considered when an infection arises after open reduction and internal fixation: implant removal and treatment of the infection or implant retention until fracture union with subsequent treatment and perhaps delayed implant removal.…”

Section: Discussionmentioning

confidence: 99%

Can Normal Fracture Healing Be Achieved When the Implant Is Retained on the Basis of Infection? An Experimental Animal Model

Bilgili

Balcı

Karaytuğ

et al. 2015

Clin Orthop Relat Res

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Background Infection after open fractures is a common complication. Treatment options for infections developed after intramedullary nailing surgery remain a topic of controversy. We therefore used a rat fracture model to evaluate the effects of infection on osseous union when the implant was maintained.Questions/purposes In a rat model, (1) does infection alter callus strength; (2) does infection alter the radiographic appearance of callus; and (3) does infection alter the histological properties of callus? Methods An open femoral fracture was created and fixed with an intramedullary Kirschner wire in 72 adult male Sprague-Dawley rats, which were divided into two study groups. In the infection group, the fracture site was contaminated with Staphylococcus aureus (36 animals), whereas in the control group, there was no bacterial contamination (36 animals). No antibiotics were used either for prophylaxis or for treatment. We performed biomechanical (maximum torque causing failure and stiffness), radiographic (Lane and Sandhu scoring for callus formation), and histologic (scoring for callus maturity) assessments at 3 and 6 weeks. The number of bacteria colonies on the femur, wire, and soft tissue inside knee were compared to validate that we successfully created an infection model. The number of bacteria colonies in the soft tissue inside the knee was higher in the infection group after 6 weeks than after the third week, demonstrating the presence of locally aggressive infection. Results Infection decreased callus strength at 6 weeks. Torque to failure (299.07 ± 65.53 Nmm versus 107.20 ± 88.81, mean difference with 95% confidence interval, 192 [43-340]; p = 0.007) and stiffness at 6 weeks (11.28 ± 2.67 Nmm versus 2.03 ± 1.68, mean difference with 95% confidence interval, 9 [3-16]; p = 0.004) both were greater in the control group than in the group with infection.

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“…Advances in wound debridement, antibiotic therapy, and tissue coverage have occurred concurrently [6,7,9,21]. Supporters of the nonreamed technique hold to the concern that reaming increases the rate of infection due to bone devascularization.…”

Section: Discussionmentioning

confidence: 99%

“…There are many studies that document the severe disruption of endosteal circulation with reaming and subsequent bone necrosis [4,16,19,25]. Klein et al demonstrated a severe vascular insult with aggressive reaming in dog tibiae [17]; Melcher showed an increased rate of infection with reaming in rabbit tibia fractures [20,21]. Further studies in closed sheep fractures demonstrated equal blood flow in fracture callous and equivalent callus strength and stiffness for reamed and nonreamed nailing [25].…”

Section: Discussionmentioning

confidence: 99%

Intramedullary nailing in open tibia fractures: a comparison of two techniques

Ziran

Darowish

Klatt

et al. 2004

International Orthopaedics (SICOT)

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We analyzed 51 patients with open tibial fractures treated with intramedullary nailing. In 29 patients the nailing was performed without reaming and in 22 after the "reamed-to-fit" technique. There was no statistically significant difference in the rate of union. The nonreamed group required a greater number of secondary procedures to achieve union and had a higher but not statistically significant incidence of infection. Analysis of the operative and anesthesia cost associated with the additional procedures revealed that on average, patients receiving nonreamed nailing incurred a cost of $4,900 more per fracture than patients of the reamed-to-fit technique. The healing rates of open tibia fractures using either minimally reamed or nonreamed techniques of intramedullary nailing are comparable. No increase in the rate of infection with the reamed-to-fit technique was found. A significant increase in the number of secondary procedures required to achieve union was found with the nonreamed nailing technique.Résumé Nous avons analysé 51 malades avec une fracture tibiale ouverte traitée par enclouage centromédul-laire. Pour 29 malades l'enclouage a été exécuté sans alésage et pour 22 avec la technique d'alésage adapté. Il n'y avait aucune différence statistique dans le taux de consolidation. Le groupe sans alésage a exigé un plus grand nombre de gestes secondaires pour obtenir la consolidation et avait un plus grande fréquence d'infection sans que cela soit statistiquement significatif. L'analyse du coût opératoire et de l'anesthésie, associée aux procédures supplémentaires montre qu'en moyenne un malade traité sans alésage a un coût de €4,100 de plus par fracture que le malade avec la technique d'alésage adapté. es taux de consolidation des fractures tibiales ouvertes en utilisant l'enclouage avec alésage adapté ou les techniques sans alésage sont comparables. Aucune augmentation dans le taux d'infection avec la technique d'alésage adapté n'a été trouvée. Une augmentation notable du nombre de procédures secondaires nécessaires pour obtenir la consolidation a été notée avec la technique de l'enclouage sans alésage.

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Infection after intramedullary nailing: An experimental investigation on rabbits

Cited by 27 publications

References 7 publications

Titanium and steel fracture fixation plates with different surface topographies: Influence on infection rate in a rabbit fracture model

Titanium and steel fracture fixation plates with different surface topographies: Influence on infection rate in a rabbit fracture model

Can Normal Fracture Healing Be Achieved When the Implant Is Retained on the Basis of Infection? An Experimental Animal Model

Intramedullary nailing in open tibia fractures: a comparison of two techniques

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