Prevention of pin track infection in external fixation with silver coated pins: Clinical and microbiological results

Massè, Alessandro; Bruno, Alberto; Bosetti, Michela; Biasibetti, A.; Cannas, M.; Gallinaro, Paolo

doi:10.1002/1097-4636(200009)53:5<600::aid-jbm21>3.0.co;2-d

Cited by 192 publications

(122 citation statements)

References 20 publications

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“…In particular, silver has raised the interest of many investigators because of its good antimicrobial action and low toxicity [30,[40][41][42][43]. On the other hand, silver has been found to have toxic effects towards human cells [44,45]. Other studies have shown that the hydroxyapatite can decrease infection by improving the compatibility of the bone [46].…”

Section: Discussionmentioning

confidence: 99%

Antibacterial iodine-supported titanium implants

et al. 2011

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Deep infection remains a serious complication in orthopedic implant surgery. In order to reduce the incidence of implant-associated infections, several biomaterial surface treatments have been proposed. This study focused on evaluating the antibacterial activity of iodine-supported titanium (Ti-I 2 ) and impact on post-implant infection, as well as determining the potential suitability of Ti-I 2 as a biomaterial.External fixation pins were used in this experiment as trial implants because it was easy to make the septic models.The antibacterial activity of the metal was measured using a modification of the Japanese Industrial Standards method. Activity was evaluated by exposing the implants to Staphylococcus aureus or Escherichia coli and comparing reaction of pathogens to the Ti-I 2 versus the stainless steel and titanium controls. The Ti-I 2 clearly inhibited bacterial colonization more than the control metals. In addition, cytocompatibility was assessed by counting the number of colonies that formed on the metals. The three metals showed the same amount of fibroblast colony formation.Japanese white rabbits were used as an in vivo model. Three pins were inserted into both femora of six rabbits for histological analysis. Pin sites were inspected and graded for infection and inflammation. Fewer signs of infection and inflammatory changes were observed in conjunction with the Ti-I 2 pins. Furthermore, osteoconductivity of the implant was evaluated with osteoid formation surface of the pin. Consecutive bone formation was observed around the Ti-I 2 and titanium pins, while little osteoid formation was found around the stainless steel pins. These findings suggest that Ti-I 2 has antimicrobial activity and cytocompatibility.Therefore, Ti-I 2 substantially reduces the incidence of implant infection and shows particular promise as a biomaterial.

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Section: Discussionmentioning

confidence: 99%

Antibacterial iodine-supported titanium implants

et al. 2011

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“…[11][12][13][14] In the field of orthopedics, there are multiple publications about silver-coatings of implants or pins for external fixation. [15][16][17][18][19] Even the use of silver in bone cement has been reported previously in the literature. [20][21][22][23] Although there were good antimicrobial effects, toxic side effects were reported as well and, as a consequence, its use was not continued.…”

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confidence: 99%

No efficacy of silver bone cement in the prevention of methicillin‐sensitive Staphylococcal infections in a rabbit contaminated implant bed model

Moojen

Charles

Fleer

et al. 2009

Journal Orthopaedic Research

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Data from literature showed that a new type of metallic silver PMMA cement had good results in infection prophylaxis. This study investigated the in vivo efficacy of silver cement in the prevention of methicillin-sensitive Staphylococcal infections, compared to plain and tobramycin-containing cement. In 48 rabbits, 0.6% silver, 1% silver, plain, or tobramycin PMMA cement was injected into the femoral medullary canal after contamination with 10 5 , 10 6 , or 10 7 colony forming units (CFU) Staphylococcus aureus. After 14 days, bone was collected for bacteriology and histopathology. All plain and silver cement rabbits were infected, whereas only two tobra rabbits were infected (p < 0.001). The number of bacteria cultured ( 10 logCFU) from bone adjacent to the cement, was 6.4 AE 0.3 and 6.1 AE 0.3 for the 0.6% and 1% silver rabbits. For the rabbits with plain and tobra cement, this was 6.2 AE 0.2 (p > 0.95) and 0.0 AE 0.0 (p < 0.001), respectively. Two tobra rabbits had a positive culture of a distal bone sample. Histological sections of plain, 0.6%, and 1% silver rabbits all showed signs of infection; these signs were absent in the tobra rabbits. Silver and plain cement were not effective in preventing infection, whereas tobra cement was effective. As silver cement predominantly exhibits an antimicrobial effect at the direct cement surface, this cement seems less useful in situations where there are bacteria present in surrounding tissues, like revision surgery. Whether silver cement has relevance in the prevention of bacterial colonization of cement remains to be determined. ß

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“…37 The difference in outcome between the results of Collinge et al 36 and those of Coester et al 37 may be explained by the lack of direct inoculation of bacteria into the pin tract in the latter. Massè et al 38 prospectively studied 24 men who were treated with monolateral external fixators for tibial or femoral diaphyseal fractures. A total of 50 screws were silver coated and were compared with 56 uncoated stainless steel screws.…”

Section: External Fixator Pinsmentioning

confidence: 99%

Silver nanoparticles and their orthopaedic applications

Brennan

Fhoghlu

Devitt

et al. 2015

The Bone & Joint Journal

145

114

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Implant-associated infection is a major source of morbidity in orthopaedic surgery. There has been extensive research into the development of materials that prevent biofilm formation, and hence, reduce the risk of infection. Silver nanoparticle technology is receiving much interest in the field of orthopaedics for its antimicrobial properties, and the results of studies to date are encouraging. Antimicrobial effects have been seen when silver nanoparticles are used in trauma implants, tumour prostheses, bone cement, and also when combined with hydroxyapatite coatings. Although there are promising results with in vitro and in vivo studies, the number of clinical studies remains small. Future studies will be required to explore further the possible side effects associated with silver nanoparticles, to ensure their use in an effective and biocompatible manner. Here we present a review of the current literature relating to the production of nanosilver for medical use, and its orthopaedic applications. Silver is a soft, white, lustrous transition metal which is recognised to have antimicrobial properties and has assumed an important role in the treatment of infections.1-3 As a non-specific biocidal agent, in suitable doses silver is not toxic to mammalian cells and disinfects a broad spectrum of bacterial and fungal species, including antibiotic-resistant strains.1-3 Silver and silver nanoparticles are used as antimicrobials in a variety of industrial, healthcare and domestic applications. 4,5 Silver has been incorporated into wound dressings, and as an antimicrobial coating on medical devices in order to prevent biofilm formation.6 The clinical potential of silver nanotechnology is of particular interest to the field of orthopaedics, where infection of implanted devices represents a persistent threat. In this paper we provide a review of the literature on the use of silver nanoparticles and their application in the field of orthopaedics. In addition, we review the potential for toxicity if silver is not used with caution.

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Prevention of pin track infection in external fixation with silver coated pins: Clinical and microbiological results

Cited by 192 publications

References 20 publications

Antibacterial iodine-supported titanium implants

Antibacterial iodine-supported titanium implants

No efficacy of silver bone cement in the prevention of methicillin‐sensitive Staphylococcal infections in a rabbit contaminated implant bed model

Silver nanoparticles and their orthopaedic applications

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