Influence of the Design for Fixation Implants on Local Infection: Experimental Study of Dynamic Compression Plates versus Point Contact Fixators in Rabbits

Arens, Stephan; Eijer, Henk; Schlegel, U.; Printzen, Gert; Perren, Stephan M.; Hansis, M.

doi:10.1097/00005131-199909000-00002

Cited by 56 publications

(45 citation statements)

References 30 publications

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“…However, we assumed that the effect of bFGF administration would be at least as significant as the effects of various osteosynthesis materials on local infection resistance. In previous investigations with the same experimental design, approximating to 1 ID50 and incorporating the previously mentioned parameters, an infection rate for the titanium dynamic compression plate of 35% had been demonstrated in contrast to 75% for the steel DCP (Arens et al 1996). In keeping with these values, we assumed an effect size of 0.4, corresponding to an infection rate of 30% (50-20) for at least one of the groups with bFGF treatment and 70% (50 + 20) for the group without bFGF treatment.…”

Section: Bacterial Inoculummentioning

confidence: 90%

“…We applied a grouped sequential experimental procedure with an "up-and-down" dosage technique. As described in previous publications, this technique allows the determination of the level of bacterial concentrations at which differences in the infection rates of the groups being compared are most evident (Melcher et al 1994, Hauke et al 1996, Arens et al 1996, 1999a, b, Kälicke et al 2003. This concentration is close to the level of the infection dose of 50% (ID 50 ) (Reed and Münch 1938).…”

Section: Bacterial Inoculummentioning

confidence: 99%

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Local application of basic fibroblast growth factor increases the risk of local infection after trauma: An in-vitro and in-vivo study in rats

et al. 2007

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Introduction Local application of growth factors to stimulate wound and fracture healing is attracting increasing interest. We studied the effect of local application of a potent angiogenic growth factor, basic fibroblast growth factor (bFGF), on resistance to local infection after soft tissue trauma.Methods For in-vitro and in-vivo experiments, we used recombinant human bFGF. The in-vitro investigations were performed by isolation of human leukocyte fractions, cytokine analysis, phagocytosis assay, flow cytometry, and LDH assay. For the in-vivo investigation, a paired comparison of infection rates was carried out on Sprague-Dawley rats after standardized, closed soft tissue trauma and local, percutaneous bacterial inoculation of different concentrations of Staphylococcus aureus (2 × 10 4 to 2 × 10 7 colony-forming units (cfu)). The lower leg was treated with 1, 10 or 100 ng bFGF (16 animals for each concentration) and without bFGF (16 animals).Results Cytotoxic reactions due to the concentrations of bFGF used could be excluded in the in-vitro tests since incubations of isolated peripheral blood mononuclear cells (PBMCs) with increasing concentrations of bFGF for 24 h did not lead to an increase in the release of lactate dehydrogenase in the culture supernatants compared to corresponding control incubations without any bFGF added. A significant increase in cytokine release was observed after the co-incubation of PBMCs with 100 or 200 ng of the same bFGF that was used for the animal experiments. Furthermore, the capacity of

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Section: Bacterial Inoculummentioning

confidence: 90%

Section: Bacterial Inoculummentioning

confidence: 99%

Local application of basic fibroblast growth factor increases the risk of local infection after trauma: An in-vitro and in-vivo study in rats

et al. 2007

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“…Biomechanical and histological testing by many investigators has shown the superiority of point contact fixator (PC-Fix) over standard and limited contact DCP in the management of fractures [1,3,7,9,17]. Plates with nuts on the undersurface that lock the screws into the holes behave in the same manner as a PC-Fix [6].…”

Section: Discussionmentioning

confidence: 99%

“…Plates with nuts on the undersurface that lock the screws into the holes behave in the same manner as a PC-Fix [6]. As the plate is not in contact with the bone, cortical vascular disrup- tion is avoided, leading to better healing potential and possibly a lower infection rate [1]. The implant loses rigidity in its position away from bone, but through the locking nuts maintains adequate stability.…”

Section: Discussionmentioning

confidence: 99%

“…However, with the new generation of plates (point contact fixator and locked plate), the stability of the construct depends upon the rigidity of the plate/screw interface rather than the high frictional forces at the bone/plate interface [6,9]. This leads to minimal interference with the periosteal circulation, reducing stress shielding and improving the biological and mechanical performance of implants as shown by laboratory [1,3,7,17] and some clinical reports [4,14].…”

Section: Introductionmentioning

confidence: 99%

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Locked plate fixation for femoral shaft fractures

El‐Sayed

Said

Abdelaal

et al. 2001

International Orthopaedics (SICOT)

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Fifteen patients with a mean age of 31 years, who had sustained different types of femoral shaft fracture, were treated by locked plate fixation using standard AO dynamic compression plates (DCP). The fracture was open in five patients and ten had other significant injuries. Thirteen patients were available for follow-up at a mean period of 5 months (range, 3-10 months). All fractures united and the mean time to full weight bearing was 8 weeks. Screw failures, with breakage or bending, occurred in five patients and resulted in loss of alignment of the fracture in one. Nine patients regained a full active range of movement of the knee, two had an extension lag of 10°and two had restricted flexion. The strength of the quadriceps muscle was grade 4 to 5 in ten patients and grade 3 in the remaining three. At the end of the study period ten patients had returned to their normal activities, one used a walking stick and two remained under a rehabilitation programme. Our preliminary results suggest that locked plates may offer a useful alternative technique for the treatment of femoral shaft fractures.Résumé Quinze malades d'âge moyen 31 ans présentant une fracture de la diaphyse fémorale ont été traités par plaque verrouillée utilisant une plaque de compression et des vis avec écrou bloquant. La fracture était ouverte cinq fois et dix malades avaient d'autres blessures associées. Treize malades ont été suivis en moyenne 5 mois. Toutes les fractures ont consolidé avec une reprise d'appui en moyenne à 8 semaines. Cinq fois les vis se sont rompues ou déformées avec, seulement dans un cas, une perte de réduction de la fracture. Neuf malades ont retrouvé une mobilité complète du genou. La force du quadriceps était cotée quatre ou cinq chez dix malades. Nos résultats préliminaires suggèrent que les plaques verouillées offrent une technique alternative utile pour le traitement des fractures de la diaphyse fémorale.

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Polylactide implants and bacterial contamination: An animal study

Mainil‐Varlet¹,

Hauke²,

Maquet³

et al. 2000

J. Biomed. Mater. Res.

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Although bioresorbable aliphatic polyesters derived from lactic acid are now used clinically as sutures, bone-fracture fixation devices and sustained-release drug-delivery systems, very little is known about their behavior in the infected environment. The aim of the present study was to compare the resistance to infection of two polylactide implants with different degradation characteristics, and to evaluate the influence of a bacterial challenge on their mechanical and physicochemical properties. Various quantities of a beta-haemolyzing strain of Staphylococus aureus (V 8189-94) were inoculated into the medullary cavity of rabbit tibiae, and an extruded polylactide rod composed of either P(L)LA (Poly(L-Lactide)) or P(L/DL)LA (Poly(L/DL-Lactide)) was then inserted. Animals were sacrificed four weeks after surgery. The tibiae and implants were removed under sterile conditions and evaluated microbiologically by culturing. The severity of infection was graded according to positive colony-forming units in the bone. The mechanical properties of the retrieved implants were assessed by 4-point bending and shear tests, performed in compliance with the ASTM D790 standard and their physicochemical characteristics also were characterized. P(L)LA and P(L/DL)LA implants were equally resistant to local infection, their mechanical and physicochemical properties being unaffected by bacterial challenge. Hence, once an infection has become established, the release of bactericidal/bacteriostatic by-products during implant degradation does not appear to affect its natural course. The release of bactericidal/bacteriostatic degradation products at the implantation site is unlikely to affect the natural course of an established infection.

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Influence of the Design for Fixation Implants on Local Infection: Experimental Study of Dynamic Compression Plates versus Point Contact Fixators in Rabbits

Abstract: After local bacterial challenge, we found a statistically significant difference in the infection rates depending on the implant design. The higher infection resistance associated with the PC-Fix design seems to be related to the reduced contact area at the bone-implant interface.

Cited by 56 publications

References 30 publications

Local application of basic fibroblast growth factor increases the risk of local infection after trauma: An in-vitro and in-vivo study in rats

Local application of basic fibroblast growth factor increases the risk of local infection after trauma: An in-vitro and in-vivo study in rats

Locked plate fixation for femoral shaft fractures

Polylactide implants and bacterial contamination: An animal study

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