Intra-medullary antibiotics perfusion (iMAP) for the control of fracture-related infection early after osteosynthesis

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110514
Author(s):  
Akihiro Maruo ◽  
Takahiro Oda ◽  
Hidetoshi Miya ◽  
Hirotsugu Muratsu ◽  
Tomoaki Fukui ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Pathogenic Bacteria ◽  
Retention Rate ◽  
Patient Characteristics ◽  
Local Drug Delivery ◽  
Fracture Union ◽  
Local Antibiotics ◽  
Implant Retention ◽  
The Mean ◽  
Local Drug Delivery System

Purpose In our hospital, cases of bone and soft tissue infections have been treated with continuous local antibiotics perfusion that allows for continuous circulation of antibiotics throughout the infected lesion. We termed this treatment “intramedullary antibiotics perfusion (iMAP)” for bone infection such as fracture-related infection (FRI) and “intrasoft tissue antibiotics perfusion” for soft tissue infection. Many cases are treated with both modalities. To introduce iMAP, this study focused on the patients with FRI treated with iMAP and reviewed their treatment outcomes. Methods We included 10 patients with FRI treated with iMAP between 2004 and 2017. The iMAP needles were inserted near the infected lesion, and an aminoglycoside antimicrobial was continuously administered. Patient characteristics, pathogenic bacteria, administered antibiotics, duration of administration, concentrations of antibiotics in blood and leachate fluid, fracture union rate, implant retention rate, and complications were studied. Results The mean age of patients was 59.9 years, and the mean follow-up period was 2.5 years. Affected bones were the tibia ( n = 8), humerus ( n = 1), and fibula ( n = 1). Deep infections developed on average 29.9 days after osteosynthesis. Pathogenic bacteria were methicillin-susceptible Staphylococcus aureus ( n = 6), methicillin-resistant S. aureus ( n = 2), and unknown ( n = 2). Average iMAP duration was 17.1 days. In all patients, infection was eradicated while preserving the implants, and fracture union was achieved without complications. Conclusion iMAP is a novel local drug delivery system allowing high concentrations of antibiotics to be administered without complications and is useful in the treatment of FRI.

scholarly journals Intramedullary antibiotic perfusion for the control of fracture-related infection early after osteosynthesis

2021 ◽  
Author(s):  
Akihiro Maruo ◽  
Takahiro Oda ◽  
Hidetoshi Miya ◽  
Hirotsugu Muratsu ◽  
Tomoaki Fukui ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Pathogenic Bacteria ◽  
Antimicrobial Agents ◽  
Retention Rate ◽  
Local Drug Delivery ◽  
Fracture Union ◽  
Implant Retention ◽  
The Mean

Abstract BackgroundIn our hospital, cases of bone and soft tissue infections have been treated with continuous local antibiotic perfusion, which allows for continuous circulation of antibiotics throughout the infected lesion. We call this treatment “intramedullary antibiotic perfusion (iMAP)” for bone infection, such as fracture-related infection (FRI), and “intra-soft tissue antibiotic perfusion” for soft tissue infection. Many cases are treated with both modalities. To introduce “iMAP,” this study focused on FRI patients treated with only iMAP and reviewed their treatment outcomes.MethodsWe included ten patients who developed FRI early after osteosynthesis and were treated with CLAP, between 2004 and 2017. The iMAP needles were inserted near the deep-seated infected lesion, and an aminoglycoside antimicrobial was continuously administered slowly. Intravenous and oral antibiotics were administered after CLAP. Patient characteristics, age, pathogenic bacteria, used antimicrobials and duration of administration, concentrations of antimicrobial agents in blood and drainage fluid, fracture union rate, implant retention rate, duration of follow-up, and complications were evaluated.ResultsThe mean patients’ age was 59.9 years, and the mean follow-up was 2.5 years. The affected bones were the tibia (8 patients), humerus (1 patient), and fibula (1 patient). Internal fixation was performed at an average of 7.5 days after the injury. Deep infections developed on average 29.9 days after the operation. Pathogenic bacteria included methicillin-susceptible Staphylococcus aureus in six patients, methicillin-resistant Staphylococcus aureus in two patients, and were unknown in two patients. CLAP was performed with astromicin, arbekacin, or gentamicin. The average duration of iMAP was 17.1 days. Antimicrobial concentrations were adjusted to appropriate levels. In all patients, the deep infection was eradicated while preserving the implants, and fracture union was achieved without any complications.ConclusionsiMAP is a novel local drug delivery system allowing high concentrations of antimicrobial agents without systemic adverse effects. It is a useful option in the treatment of FRI where implant retention is desired.

Percutaneous removal of a soft tissue cement leakage complicating a percutaneous vertebroplasty by the mean of a supple biopsy forceps

2013 ◽  
Vol 40 (2) ◽  
pp. 140-142 ◽  
Author(s):  
Jérémie Durrleman ◽  
Frédéric Clarençon ◽  
Evelyne Cormier ◽  
Lise Le Jean ◽  
Jacques Chiras
Keyword(s):  
Soft Tissue ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Biopsy Forceps ◽  
Percutaneous Removal ◽  
The Mean

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Goki Kamei ◽  
Shigeki Ishibashi ◽  
Koki Yoshioka ◽  
Satoru Sakurai ◽  
Hiroyuki Inoue ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Distal Femur ◽  
Gap Size ◽  
Flexion Gap ◽  
Gap Technique ◽  
Joint Gap ◽  
Total Knee ◽  
The Mean

Abstract Background In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap. Methods This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component. Results The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°). Conclusions In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.

scholarly journals Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jianmin Xu ◽  
Rui Chang ◽  
Wei Zhang ◽  
Chengcheng Zhang ◽  
Dezhi Zhu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hair Growth ◽  
Wound Closure ◽  
Skin Wound ◽  
Soft Tissue Defects ◽  
Cutaneous Sensation ◽  
The Mean ◽  
Skin Stretch ◽  
Mean Time ◽  
Tissue Defects

Abstract Background To investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds. Methods From June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded. Results There were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal. Conclusions This study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

scholarly journals Non-locking buttress plate in distal tibial metaphyseal fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 87-91
Author(s):  
Norman Lamichhane ◽  
Bhogendra Bahadur KC ◽  
Chandra Bahadur Mishra ◽  
Sabita Dhakal
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Delayed Union ◽  
Full Weight Bearing ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Metaphyseal Fractures

Background: Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures. Material and methods: Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared. Results: The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion. Conclusion: Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.

Evaluation of osteogenesis and angiogenesis of icariin loaded on micro/nano hybrid structured hydroxyapatite granules as a local drug delivery system for femoral defect repair

2015 ◽  
Vol 3 (24) ◽  
pp. 4871-4883 ◽  
Author(s):  
Yuqiong Wu ◽  
Lunguo Xia ◽  
Yuning Zhou ◽  
Wudi Ma ◽  
Na Zhang ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Osteogenic Differentiation ◽  
Drug Delivery System ◽  
Local Drug Delivery ◽  
Bone Mesenchymal Stem Cells ◽  
Femoral Defect ◽  
Defect Repair ◽  
Local Drug Delivery System

Icariin has been identified to promote osteogenic differentiation of bone mesenchymal stem cells (BMSCs).

Differences in Acute Ischemic Stroke Management and Prognosis between Multiple Large-Vessel Occlusion and Single Large-Vessel Occlusion: Subanalysis of the RESCUE-Japan Registry 2

2021 ◽  
Vol 50 (4) ◽  
pp. 397-404
Author(s):  
Kotaro Tatebayashi ◽  
Kazutaka Uchida ◽  
Hiroto Kageyama ◽  
Hirotoshi Imamura ◽  
Nobuyuki Ohara ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Characteristics ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Tandem Occlusion ◽  
The Mean ◽  
Patient Prognosis

<b><i>Introduction:</i></b> The management and prognosis of acute ischemic stroke due to multiple large-vessel occlusion (LVO) (MLVO) are not well scrutinized. We therefore aimed to elucidate the differences in patient characteristics and prognosis of MLVO and single LVO (SLVO). <b><i>Methods:</i></b> The Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2 (RESCUE-Japan Registry 2) enrolled 2,420 consecutive patients with acute LVO who were admitted within 24 h of onset. We compared patient prognosis between MLVO and SLVO in the favorable outcome, defined as a modified Rankin Scale (mRS) score ≤2, and in mortality at 90 days by adjusting for confounders. Additionally, we stratified MLVO patients into tandem occlusion and different territories, according to the occlusion site information and also examined their characteristics. <b><i>Results:</i></b> Among the 2,399 patients registered, 124 (5.2%) had MLVO. Although there was no difference between the 2 groups in terms of hypertension as a risk factor, the mean arterial pressure on admission was significantly higher in MLVO (115 vs. 107 mm Hg, <i>p</i> = 0.004). MLVO in different territories was more likely to be cardioembolic (42.1 vs. 10.4%, <i>p</i> = 0.0002), while MLVO in tandem occlusion was more likely to be atherothrombotic (39.5 vs. 81.3%, <i>p</i> &#x3c; 0.0001). Among MLVO, tandem occlusion had a significantly longer onset-to-door time than different territories (200 vs. 95 min, <i>p</i> = 0.02); accordingly, the tissue plasminogen activator administration was significantly less in tandem occlusion (22.4 vs. 47.9%, <i>p</i> = 0.003). However, interestingly, the endovascular thrombectomy (EVT) was performed significantly more in tandem occlusion (63.2 vs. 41.7%; adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1–5.0). The type of MLVO was the only and significant factor associated with EVT performance in multivariate analysis. The favorable outcomes were obtained less in MLVO than in SLVO (28.2 vs. 37.1%; aOR, 0.48; 95% CI, 0.30–0.76). The mortality rate was not significantly different between MLVO and SLVO (8.9 vs. 11.1%, <i>p</i> = 0.42). <b><i>Discussion/Conclusion:</i></b> The prognosis of MLVO was significantly worse than that of SLVO. In different territories, we might be able to consider more aggressive EVT interventions.

scholarly journals Early Results of Total Knee Arthroplasty with a Low Contact Stress Anteroposterior Glide

2009 ◽  
Vol 17 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Adrian J Bauze ◽  
Mark S Falworth ◽  
Roger D Oakeshott
Keyword(s):  
Soft Tissue ◽  
Contact Stress ◽  
Cruciate Ligament ◽  
Valgus Deformity ◽  
Rotating Platform ◽  
Active Flexion ◽  
Early Results ◽  
Total Knee ◽  
The Mean ◽  
Low Contact Stress

Purpose. To present early results of 400 consecutive low contact stress (LCS) anteroposterior (AP) glide total knee arthroplasties (TKAs) performed by a single surgeon. Methods. 304 consecutive patients aged 30 to 96 (mean, 66) years underwent 400 TKAs using LCS AP glides performed by a single surgeon. Only patients with an intact posterior cruciate ligament, a fixed flexion deformity of <15°, and a valgus deformity of <15° were included. Patients were assessed pre- and post-operatively using the American Knee Society (AKS) and Hospital for Special Surgery (HSS) scores. Range of motion was measured using a goniometer. AP and lateral radiographs were assessed for radiolucencies and osteolysis. Results. The mean follow-up period was 4.2 (range, 1–8) years. The mean fixed flexion improved to 1° from 11° and the mean active flexion improved to 120° from 111°. Both AKS and HSS scores improved significantly. There were 28 anterior soft tissue impingements; 9 of them were in the first year of the study. Thereafter, the anterior lip of the bearing was modified and any offending osteophytes, soft tissue, or fat pads were excised. Of 39 (10%) knees that underwent re-operation (16 were due to anterior soft tissue impingement), 20 (5%) did not require change of the AP glide bearing and the remaining 19 were converted to a rotating platform bearing. No patellar baja was noted after fat pad excision. No patient had catastrophic wear or failure of the polyethylene bearing. The survival rate of the AP glide bearing was 95%. Conclusion. The early-to-mid-term outcomes of the LCS AP glide TKA are promising.

Sign in / Sign up

Export Citation Format

Share Document